Individual
DR. KENT E. IBANEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2160 S 1ST AVE, MAYWOOD, IL 60153-3328
(708) 216-9000
Mailing address
12554 RIATA VISTA CIR, AUSTIN, TX 78727-6431
(512) 795-5100
(512) 795-5122
Taxonomy
Speciality
Code
Description
License number
State
2085N0700X
Neuroradiology Physician
TEMP
TX
2085R0202X
Diagnostic Radiology Physician
036169257
IL
2085R0202X
Diagnostic Radiology Physician
22674
ND
2085R0202X
Diagnostic Radiology Physician
Primary
M3269
TX
2085R0202X
Diagnostic Radiology Physician
ME170240
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
179932201
CSHCN2
TX
05
—
179932201
—
TX
05
—
179932202
—
TX
01
—
179932203
CSHCN1
TX
01
—
22557
NEBRASKA MEDICAL LICENSE
NE
01
—
P00360851
RRMCARE
—
Enumeration date
03/22/2006
Last updated
12/05/2025
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