Healthcare Provider Details

I. General information

NPI: 1366804874
Provider Name (Legal Business Name): AARON M KEARNEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2016
Last Update Date: 01/02/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12255 S 80TH AVE STE 204
PALOS HEIGHTS IL
60463-1284
US

IV. Provider business mailing address

12255 S 80TH AVE STE 204
PALOS HEIGHTS IL
60463-1284
US

V. Phone/Fax

Practice location:
  • Phone: 708-923-4400
  • Fax: 708-923-4295
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number036148309
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number036148309
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: