Healthcare Provider Details

I. General information

NPI: 1982860920
Provider Name (Legal Business Name): KORI SUMMERS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2008
Last Update Date: 09/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1460 N. HALSTED ST SUITE 402
CHICAGO IL
60642
US

IV. Provider business mailing address

1460 N. HALSTED ST SUITE 402
CHICAGO IL
60642
US

V. Phone/Fax

Practice location:
  • Phone: 312-279-8900
  • Fax: 312-981-6312
Mailing address:
  • Phone: 312-279-8900
  • Fax: 312-981-6312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number125-053990
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: