Organization
IL S KWAK MD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. IL S KWAK M.D (PRESIDENT)
(260) 637-3939
Entity
Organization
Contact information
Practice address
2222 TIMBERBROOK TRL, FORT WAYNE, IN 46845-9530
(260) 637-3939
(260) 637-3939
Mailing address
2222 TIMBERBROOK TRL, FORT WAYNE, IN 46845
(260) 637-3939
(260) 637-3939
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
01026132A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100054590A
—
IN
Enumeration date
10/23/2007
Last updated
07/08/2010
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