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Individual

BORIS KUSNETZOW

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
6642 S ASHLAND AVE, CHICAGO, IL 60636-3022
(773) 776-3500
(773) 776-8534
Mailing address
6642 S ASHLAND AVE, CHICAGO, IL 60636-3022
(773) 776-3500
(773) 776-8534

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036071405
IL

Other

Enumeration date
11/30/2006
Last updated
07/08/2007
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