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General NPI Number Information
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NPI Number | 1124675244
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Entity Type | Organization
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Legal Business Name | KIRACOFE MD MEDICAL, LLC
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Dates
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Enumeration Date | 08/22/2019
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Last Update Date | 12/19/2025
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Provider Practice Location Address
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Address Line | 618 W FULTON ST
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City | CHICAGO
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State | IL
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Zip | 60661-1144
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Country | US
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Telephone | 847-766-0829
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Fax | 847-892-4992
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Provider Business Mailing Address
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Address Line | 618 W FULTON ST
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City | CHICAGO
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State | IL
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Zip | 60661-1144
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Country | US
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Telephone | 847-766-0829
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Fax | 847-892-4992
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Authorized Official
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Title or Position | MD/CEO
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Name | ELIZABETH KIRACOFE
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Credential | MD
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Telephone | 847-766-0829
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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