Individual
DR. KENNY BOZORGI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
409 W HURON ST, SUITE 301, CHICAGO, IL 60654-3431
(312) 787-7861
(312) 787-7916
Mailing address
409 W HURON ST, SUITE 301, CHICAGO, IL 60654-3431
(312) 787-7861
(312) 787-7916
Taxonomy
Speciality
Code
Description
License number
State
207VX0201X
Gynecologic Oncology Physician
Primary
036090621
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PO85733J9
—
IL
Enumeration date
06/16/2009
Last updated
06/16/2009
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