Provider Demographics
NPI:1538146758
Name:KENTOR, PAUL M (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:M
Last Name:KENTOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:580 ROGER WILLIAMS AVE STE 25
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-4820
Mailing Address - Country:US
Mailing Address - Phone:847-634-1960
Mailing Address - Fax:847-864-0661
Practice Address - Street 1:580 ROGER WILLIAMS AVE STE 25
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-4820
Practice Address - Country:US
Practice Address - Phone:847-634-1960
Practice Address - Fax:847-864-0661
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036044332207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL210357OtherGROUP
ILK12415Medicare PIN
ILC39838Medicare UPIN