Active NPI
Kenneth C Wolford, CSA
- Specialist
- Hanover Park, IL
National Provider Identifier
1114996287
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 23B.000007
- Practice address
- 7078 West Ave
Hanover Park, IL 60133 - Phone
- (630) 378-1225
- Fax
- (630) 378-1740
- NPI assigned
- Mar 14, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 23B.000007 | IL | Primary |
Addresses
Primary practice location
7078 West Ave
Hanover Park, IL 60133
Mailing address
7078 West Ave
Hanover Park, IL 60133
Phone (813) 854-1664
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 23B.000007 | IL | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1142294400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1233878400000",
"number": "1114996287",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7078 WEST AVE",
"city": "HANOVER PARK",
"state": "IL",
"postal_code": "60133",
"telephone_number": "813-854-1664",
"fax_number": "630-378-1740"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7078 WEST AVE",
"city": "HANOVER PARK",
"state": "IL",
"postal_code": "60133",
"telephone_number": "630-378-1225",
"fax_number": "630-378-1740"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WOLFORD",
"first_name": "KENNETH",
"middle_name": "C",
"name_prefix": "Mr.",
"credential": "CSA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-14",
"last_updated": "2009-02-06",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "IL",
"license": "23B.000007",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hanover Park, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.