Healthcare Provider Details

I. General information

NPI: 1710066436
Provider Name (Legal Business Name): KEDZIE MEDICAL ASSOCIATES,LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9760 S KEDZIE AVE SUITE#2
EVERGREEN PARK IL
60805-3109
US

IV. Provider business mailing address

7960 SOUTH KEDZIE AVENUE SUITE#2
EVERGREEN PARK IL
60805
US

V. Phone/Fax

Practice location:
  • Phone: 708-423-6800
  • Fax: 708-423-0402
Mailing address:
  • Phone: 708-423-6800
  • Fax: 708-423-0402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. RICHARD H KYI
Title or Position: MEDICAL DIRECTOR
Credential: M.D
Phone: 708-423-6800