Healthcare Provider Details

I. General information

NPI: 1114842929
Provider Name (Legal Business Name): KYLE EPPS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1135 SKOKIE BLVD
NORTHBROOK IL
60062-4118
US

IV. Provider business mailing address

3833 N BROADWAY ST APT 408
CHICAGO IL
60613-5673
US

V. Phone/Fax

Practice location:
  • Phone: 224-505-5537
  • Fax:
Mailing address:
  • Phone: 515-770-5159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: