Healthcare Provider Details

I. General information

NPI: 1447594619
Provider Name (Legal Business Name): HIGHLAND PARK MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2012
Last Update Date: 05/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 CENTRAL AVE SUITE 144
HIGHLAND PARK IL
60035-3211
US

IV. Provider business mailing address

600 CENTRAL AVE SUITE 144
HIGHLAND PARK IL
60035-3211
US

V. Phone/Fax

Practice location:
  • Phone: 847-266-5656
  • Fax: 847-266-5658
Mailing address:
  • Phone: 847-266-5656
  • Fax: 847-266-5658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038007889
License Number StateIL

VIII. Authorized Official

Name: MICHAEL N. KAUF
Title or Position: PRESIDENT
Credential: D.C.
Phone: 847-266-5656