Individual
DR. KENNETH S OBARSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
425 HUEHL RD, UNIT 13, NORTHBROOK, IL 60062-2322
(847) 504-5000
(847) 504-5015
Mailing address
10580 OLCOTT AVE, ST JOHN, IN 46373-8942
(219) 558-8540
(219) 627-4040
Taxonomy
Speciality
Code
Description
License number
State
213EP1101X
Primary Podiatric Medicine Podiatrist
Primary
016-003964
IL
213EP1101X
Primary Podiatric Medicine Podiatrist
07000623A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
016003964
—
IL
01
—
110025242
RAILROAD MEDICARE
IL
05
—
200224560A
—
IN
01
—
6000164646
BLUE CROSS/BLUE SHIELD
IL
Enumeration date
02/23/2006
Last updated
05/12/2014
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