Basic Information
Provider Information
NPI: 1003011966
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KALLSNICK
FirstName: AARON
MiddleName: DANIEL
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1301 W 22ND ST
Address2: #610
City: OAK BROOK
State: IL
PostalCode: 605232006
CountryCode: US
TelephoneNumber: 6305371720
FaxNumber:  
Practice Location
Address1: 5645 W ADDISON ST
Address2:  
City: CHICAGO
State: IL
PostalCode: 606344403
CountryCode: US
TelephoneNumber: 7732827000
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/19/2007
LastUpdateDate: 05/09/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000X036.127038ILY Allopathic & Osteopathic PhysiciansAnesthesiology 

No ID Information.


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