MEDICARE: DR. KENNETH WILLIAM PARK D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	036055468	IL

General Provider Information

NPI Number	:	1114928801
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH WILLIAM PARK D.O.

Provider Business Mailing Address
First Line	:	125 CARLISLE CT
Second Line	:
City	:	CARY
State	:	IL
Zip	:	60013-1908
Country	:	US
Telephone Number	:	847-639-1685
Fax Number	:

Provider Business Practice Location Address
First Line	:	125 CARLISLE CT
Second Line	:
City	:	CARY
State	:	IL
Zip	:	60013-1908
Country	:	US
Telephone Number	:	847-639-1685
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2005
Last Update Date	:	08/13/2009

Similar Medicare Providers

1316908619 — MRS. GRETCHEN ANN BERGEN M.A., SLP/L
Practice Location Address:

1212 MINK TRL
CARY, IL
60013-6066

Practice Phone: 847-639-7963
Practice Fax: 847-639-1506

1730143504 — DR. ALAN R. BARTHEN D.C.
Practice Location Address:

395 CARY ALGONQUIN RD , SUITE C
CARY, IL
60013-2090

Practice Phone: 847-639-0010
Practice Fax: 847-639-9233

1124072459 — DR. JAMES C MASSARO DPM
Practice Location Address:

113 W MAIN ST
CARY, IL
60013-2718

Practice Phone: 847-639-5800
Practice Fax: 847-639-2980

1417901364 — DR. JONATHAN EDWIN BROWN D.C.
Practice Location Address:

875 FEINBERG CT , STE 104
CARY, IL
60013-2981

Practice Phone: 773-267-0020
Practice Fax:

1104872878 — AMERICAN DRUG STORES LLC
Practice Location Address:

696 NORTHWEST HWY
CARY, IL
60013

Practice Phone: 847-639-3652
Practice Fax: 847-639-9133

1194763359 — DR. KATHERINE SUZANNE DELGADILLO O.D.
Practice Location Address:

855 FEINBERG CT
CARY, IL
60013-2976

Practice Phone: 847-516-3111
Practice Fax:

Directions to “ DR. KENNETH WILLIAM PARK D.O.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.