Healthcare Provider Details

I. General information

NPI: 1669741518
Provider Name (Legal Business Name): K MEDICAL, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2011
Last Update Date: 10/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 LAUREL DR
FAIRVIEW HEIGHTS IL
62208-2421
US

IV. Provider business mailing address

3651 N TRIPP AVE
CHICAGO IL
60641-3038
US

V. Phone/Fax

Practice location:
  • Phone: 773-895-3668
  • Fax:
Mailing address:
  • Phone:
  • 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: DR. KAREN HUNT
Title or Position: PRESIDENT
Credential: DPM
Phone: 773-895-3668