MEDICARE: LILLIAN KEAN KAMALESON LCPM, CPM

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	176B00000X	Midwife	CPM25090844	IL

General Provider Information

NPI Number	:	1548111602
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LILLIAN KEAN KAMALESON LCPM, CPM

Provider Business Mailing Address
First Line	:	6503 S HERMITAGE AVE APT 2
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60636-3011
Country	:	US
Telephone Number	:	773-875-3296
Fax Number	:

Provider Business Practice Location Address
First Line	:	6503 S HERMITAGE AVE APT 2
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60636-3011
Country	:	US
Telephone Number	:	773-875-3296
Fax Number	:

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

Provider Enumeration Date	:	02/05/2026
Last Update Date	:	02/19/2026

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