Healthcare Provider Details

I. General information

NPI: 1952759755
Provider Name (Legal Business Name): KEVIN BAIDOO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2016
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3249 OAK PARK AVE
BERWYN IL
60402-3429
US

IV. Provider business mailing address

885 ROOSEVELT RD STE 300
GLEN ELLYN IL
60137-6141
US

V. Phone/Fax

Practice location:
  • Phone: 215-668-5058
  • Fax:
Mailing address:
  • Phone: 630-225-2663
  • Fax: 630-225-2399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number125069210
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number036152726
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number036.152726
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: