Healthcare Provider Details

I. General information

NPI: 1487864542
Provider Name (Legal Business Name): KYRA PAYNE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3348 W 87TH ST
CHICAGO IL
60652-3767
US

IV. Provider business mailing address

PO BOX 746715
ATLANTA GA
30374-6715
US

V. Phone/Fax

Practice location:
  • Phone: 773-776-4471
  • Fax:
Mailing address:
  • Phone: 773-776-4471
  • Fax: 773-564-3510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036.117082
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number036.117082
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: