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Individual

KYLE R. PILZ

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
P.A.

Contact information

Practice address
1611 W HARRISON ST STE 400, CHICAGO, IL 60612-4861
(877) 632-6637
(708) 409-5179
Mailing address
1611 W HARRISON ST STE 400, CHICAGO, IL 60612-4861
(877) 632-6637
(708) 409-5179

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
10003828A
IN
363AS0400X
Surgical Physician Assistant
Primary
085002192
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
209118
MEDICARE PTAN LOCALITY 15
IL
01
209119
MEDICARE PTAN LOCALITY 16
IL
Enumeration date
05/30/2006
Last updated
06/16/2023
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