Healthcare Provider Details

I. General information

NPI: 1619679404
Provider Name (Legal Business Name): KADIR BUYUKCELEBI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2023
Last Update Date: 03/17/2023
Certification Date: 03/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4646 N MARINE DR INTERNAL MEDICINE DEPARTMENT
CHICAGO IL
60640
US

IV. Provider business mailing address

811 W AGATITE AVE APT 2416
CHICAGO IL
60640-6214
US

V. Phone/Fax

Practice location:
  • Phone: 773-878-8700
  • Fax:
Mailing address:
  • Phone: 773-815-3792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125081113
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: