Organization
KISHWAUKEE PHYSICIAN GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CHRISTINE ZYDEK (DIRECTOR OF FINANCE)
(815) 748-2986
Entity
Organization
Contact information
Practice address
1 KISH HOSPITAL DR, DEKALB, IL 60115-9602
(815) 756-1521
Mailing address
PO BOX 487, DEKALB, IL 60115-0487
(815) 756-1521
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
208800000X
Urology Physician
—
—
208D00000X
General Practice Physician
Primary
—
—
Other
Enumeration date
09/07/2011
Last updated
04/16/2018
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