Healthcare Provider Details

I. General information

NPI: 1679908396
Provider Name (Legal Business Name): K MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2013
Last Update Date: 09/06/2023
Certification Date: 05/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3631 N HARLEM AVE
CHICAGO IL
60634-2237
US

IV. Provider business mailing address

511 HIGHVIEW DR
FOX RIVER GROVE IL
60021-1107
US

V. Phone/Fax

Practice location:
  • Phone: 773-895-3668
  • Fax: 708-933-3000
Mailing address:
  • Phone: 773-895-3668
  • Fax: 708-933-3000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number016-004758
License Number StateIL

VIII. Authorized Official

Name: KAREN HUNT
Title or Position: PRESIDENT
Credential: DPM
Phone: 773-895-3668