Healthcare Provider Details

I. General information

NPI: 1003047267
Provider Name (Legal Business Name): RAELENE D KENNEDY KIM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RAELENE D KENNEDY MD

II. Dates (important events)

Enumeration Date: 08/05/2009
Last Update Date: 11/17/2025
Certification Date: 11/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 DELNOR DR STE 400
GENEVA IL
60134-4228
US

IV. Provider business mailing address

351 DELNOR DR STE 400
GENEVA IL
60134-4228
US

V. Phone/Fax

Practice location:
  • Phone: 630-668-0833
  • Fax: 630-208-4373
Mailing address:
  • Phone: 630-668-0833
  • Fax: 630-208-4373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number036-148573
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number036148573
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036-148573
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: