Healthcare Provider Details

I. General information

NPI: 1982022810
Provider Name (Legal Business Name): KIRK VAN SHEPARD II MD, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2014
Last Update Date: 07/22/2020
Certification Date: 07/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 N HALSTED ST STE 400
CHICAGO IL
60657-8480
US

IV. Provider business mailing address

3000 N HALSTED ST STE 400
CHICAGO IL
60657-8480
US

V. Phone/Fax

Practice location:
  • Phone: 773-296-5500
  • Fax:
Mailing address:
  • Phone: 773-296-5500
  • Fax: 773-296-3800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number036.151294
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036.151294
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: