Basic Information
| Provider Information | |||||||||
| NPI: | 1154647980 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARANG | ||||||||
| FirstName: | KENNETH | ||||||||
| MiddleName: | PATRICK | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2650 RIDGE AVE STE 4210 | ||||||||
| Address2: | |||||||||
| City: | EVANSTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 602011700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8475701010 | ||||||||
| FaxNumber: | 8477335108 | ||||||||
| Practice Location | |||||||||
| Address1: | 2650 RIDGE AVE STE 4210 | ||||||||
| Address2: | |||||||||
| City: | EVANSTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8475701010 | ||||||||
| FaxNumber: | 8477335108 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2010 | ||||||||
| LastUpdateDate: | 10/08/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | 036133294 | IL | Y | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 036133294 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.