MEDICARE: MICHELLAI KIERRA PARKS MD

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	208000000X	Pediatrics Physician	036.175760	IL

General Provider Information

NPI Number	:	1619606696
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLAI KIERRA PARKS MD

Provider Business Mailing Address
First Line	:	8455 S PHILLIPS AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60617-1971
Country	:	US
Telephone Number	:	773-726-7274
Fax Number	:

Provider Business Practice Location Address
First Line	:	1411 S MICHIGAN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60605-2810
Country	:	US
Telephone Number	:	312-454-2700
Fax Number	:

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

Provider Enumeration Date	:	06/06/2022
Last Update Date	:	06/30/2025

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