Individual
KANESHA L BRYANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1 SALT CREEK LN, HINSDALE, IL 60521-2936
(630) 286-5500
Mailing address
1 SALT CREEK LN, HINSDALE, IL 60521-2936
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
03615163
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036115163
—
IL
01
—
IL3323007
MEDICARE PTAN
IL
Enumeration date
06/23/2008
Last updated
03/11/2021
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