Healthcare Provider Details

I. General information

NPI: 1447741756
Provider Name (Legal Business Name): KEVIN KEUPER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2018
Last Update Date: 06/10/2021
Certification Date: 06/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 E OGDEN AVE STE 202
WESTMONT IL
60559-1296
US

IV. Provider business mailing address

700 E OGDEN AVE STE 202
WESTMONT IL
60559-1296
US

V. Phone/Fax

Practice location:
  • Phone: 630-528-3215
  • Fax: 630-528-3219
Mailing address:
  • Phone: 630-528-3215
  • Fax: 630-528-3219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036156429
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125.072126
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036156429
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: