Individual
JACQUELINE L KANNAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
4119 W SHAMROCK LN, MCHENRY, IL 60050-8268
(815) 398-9491
(815) 381-7498
Mailing address
BOX 78534, MILWAUKEE, WI 53278-8534
(815) 398-9491
(815) 381-7498
Taxonomy
Speciality
Code
Description
License number
State
207RR0500X
Rheumatology Physician
Primary
036-152551
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
125073073
—
IL
Enumeration date
03/26/2015
Last updated
12/21/2021
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