Individual
KENRICK L ROBERTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
2850 W 95TH ST, SUITE 301, EVERGREEN PARK, IL 60805-2735
(708) 389-2200
Mailing address
PO BOX 26975, JACKSONVILLE, FL 32226-6975
(773) 450-5709
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085-003520
IL
363AM0700X
Medical Physician Assistant
085003520
IL
363AS0400X
Surgical Physician Assistant
085003520
IL
Other
Enumeration date
02/17/2010
Last updated
04/29/2021
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