Healthcare Provider Details

I. General information

NPI: 1003041476
Provider Name (Legal Business Name): KEVIN D LINDGREN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2009
Last Update Date: 04/05/2022
Certification Date: 04/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 S MAPLE AVE STE 5500
OAK PARK IL
60304-2808
US

IV. Provider business mailing address

610 S MAPLE AVE STE 5500
OAK PARK IL
60304-2808
US

V. Phone/Fax

Practice location:
  • Phone: 708-660-5777
  • Fax: 708-660-2330
Mailing address:
  • Phone: 708-660-5777
  • Fax: 708-660-2330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number59927
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number036-129957
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number125-56138
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License Number036-129957
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: