Individual
CARLY KAMINKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
400 RIVERSIDE DR STE 1600, BOURBONNAIS, IL 60914-5406
(815) 802-7090
(815) 802-7091
Mailing address
400 RIVERSIDE DR STE 1600, BOURBONNAIS, IL 60914-5406
(815) 802-7090
(815) 802-7091
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085006802
IL
Other
Enumeration date
08/23/2018
Last updated
03/22/2021
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