Provider Demographics
NPI:1912146119
Name:KBCLINIC
Entity Type:Organization
Organization Name:KBCLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:KARIN
Authorized Official - Middle Name:ANNIKA
Authorized Official - Last Name:BLUMOFE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-227-2274
Mailing Address - Street 1:6838 N KILPATRICK AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712-2437
Mailing Address - Country:US
Mailing Address - Phone:847-763-9241
Mailing Address - Fax:
Practice Address - Street 1:5666 EAST STATE STREET
Practice Address - Street 2:AMBULATORY SURGERY CENTER/ DR BLUMOFE
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-2425
Practice Address - Country:US
Practice Address - Phone:815-227-2274
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-11
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036093795208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty