Individual
MR. KAJORNDEJ KOMUTANON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3218 W LAWRENCE AVE, CHICAGO, IL 60625-5209
(773) 588-6846
(733) 588-6847
Mailing address
6543 W ALBERT AVENUE, MORTON GROVE, IL 60053-1402
(847) 966-1957
(773) 588-6847
Taxonomy
Speciality
Code
Description
License number
State
207KA0200X
Allergy Physician
Primary
036046966
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036046966
—
IL
Enumeration date
08/09/2005
Last updated
11/29/2013
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