Healthcare Provider Details

I. General information

NPI: 1801473624
Provider Name (Legal Business Name): DONOVAN KEARNS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2021
Last Update Date: 01/11/2026
Certification Date: 01/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1455 E GOLF RD STE 104
DES PLAINES IL
60016-1253
US

IV. Provider business mailing address

1455 E GOLF RD STE 104
DES PLAINES IL
60016-1253
US

V. Phone/Fax

Practice location:
  • Phone: 847-699-3101
  • Fax: 847-699-3104
Mailing address:
  • Phone: 847-699-3101
  • Fax: 847-699-3104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number036.176703
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: