KENILWORTH MEDICAL ASSOCIATES, S.C. - NPI 1366579054 - Allergy & Immunology in Kenilworth, IL

Q: What is Kenilworth Medical Associates, S.C.'s NPI number?

The NPI number for Kenilworth Medical Associates, S.C. is 1366579054. It was assigned to this organization in the NPPES registry on February 28, 2007.

Q: What is Kenilworth Medical Associates, S.C.'s specialty?

The primary specialty registered for this NPI is Allergy & Immunology with taxonomy code 207K00000X.

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About Kenilworth Medical Associates, S.c. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KENILWORTH MEDICAL ASSOCIATES, S.C. (NPI 1366579054) is a healthcare organization registered as an allergy & immunology in Kenilworth, Illinois and active in the NPI registry since February 2007. The organization holds a CLIA Waiver certificate valid through December 1, 2027 and lists Paul Detjen, President, as its authorized official.

NPPES Registry Identity

NPI1366579054

Entity TypeOrganization

Primary Taxonomy207K00000X

Legal Business NameKENILWORTH MEDICAL ASSOCIATES, S.C.

Location Address534 GREEN BAY RDKenilworth, IL 60043-1801

Mailing Address534 Green Bay RdKenilworth, IL 60043-1801 · (847) 256-5505 · Fax (847) 256-5567

Phone(847) 256-5505

Fax(847) 256-5567

Organization SubpartNo

Authorized OfficialPaul DetjenPresident · (847) 256-5505

Enumeration DateFebruary 28, 2007

Last NPPES UpdateNovember 20, 2014

✔ NPI 1366579054 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyAllergy & ImmunologyAllopathic & Osteopathic Physicians

Taxonomy Code207K00000X

License✔ Licensed in IL · 036072795

Definition

An allergist-immunologist is trained in evaluation, physical and laboratory diagnosis, and management of disorders involving the immune system. Selected examples of such conditions include asthma, anaphylaxis, rhinitis, eczema, and adverse reactions to drugs, foods, and insect stings as well as immune deficiency diseases (both acquired and congenital), defects in host defense, and problems related to autoimmune disease, organ transplantation, or malignancies of the immune system.

534 GREEN BAY RD, Kenilworth, IL 60043

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Other Identifiers 3

Medicaid036072795IL

Medicare UPINL72499IL

Medicare ID-Type Unspecified553740IL

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 14D0869087

Kenilworth Medical Associates · Kenilworth, IL

Active · expires Dec 1, 2027

CLIA Number14D0869087

Laboratory TypePhysician Office

Certificate Effective DateDecember 2, 2025

Certificate Expiration DateDecember 1, 2027

Laboratory DirectorPaul F. Detjen MD

Laboratory Phone(847) 256-5505

Laboratory LocationKenilworth Medical Associates534 Green Bay Road, Kenilworth, IL 60043

CLIA data matches this NPI record on: Address Name Phone

This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 9

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DAVID S. DUDA DDS PC

Dentist (General Practice)