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NPI Code Detail

MEDICARE: KENZIE KITCHAROEN M.D.

MEDICARE: KENZIE KITCHAROEN M.D.
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
12084P0800XPsychiatry Physician036124514IL

General Provider Information

NPI Number : 1356533269
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENZIE KITCHAROEN M.D.
Provider Business Mailing Address
First Line : 899 SKOKIE BLVD SPC 333
Second Line :
City : NORTHBROOK
State : IL
Zip : 60062-4023
Country : US
Telephone Number : 847-834-1428
Fax Number : 855-265-2722
Provider Business Practice Location Address
First Line : 515 VALLEY ST STE 203
Second Line :
City : MAPLEWOOD
State : NJ
Zip : 07040-4300
Country : US
Telephone Number : 908-663-2929
Fax Number : 908-219-6213
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/14/2007
Last Update Date : 08/18/2025

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