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General NPI Number Information
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NPI Number | 1295645372
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Entity Type | Individual
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Provider Name | KYLIE CLEVENGER PA
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Gender | Female
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Dates
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Enumeration Date | 09/10/2026
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Last Update Date | 09/10/2026
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Provider Practice Location Address
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Address Line | 5851 W 95TH ST STE 300
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City | OAK LAWN
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State | IL
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Zip | 60453-2415
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Country | US
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Telephone | 708-499-9800
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Fax | 708-499-6203
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Provider Business Mailing Address
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Address Line | 5851 W 95TH ST STE 300
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City | OAK LAWN
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State | IL
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Zip | 60453-2415
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Country | US
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Telephone | 708-499-9800
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Fax | 708-499-6203
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2088F0040X
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Taxonomy Name | Urogynecology and Reconstructive Pelvic Surgery (Urology) Physician
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License Number | 085012406
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License Number State | IL
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