Individual
JOSEPH A KMIECIK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
626 BETHANY ROAD, DEKALB, IL 60115-4929
(815) 756-1521
Mailing address
626 BETHANY RD, DEKALB, IL 60115-4939
(815) 756-1521
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
036111141
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0361111411
—
IL
Enumeration date
08/24/2006
Last updated
10/07/2025
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