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General NPI Number Information
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NPI Number | 1972769222
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Entity Type | Individual
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Provider Name | KIRK KITTIKAMRON D.O.
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Gender | Male
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Dates
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Enumeration Date | 08/05/2008
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Last Update Date | 04/02/2021
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Provider Practice Location Address
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Address Line | 5145 N CALIFORNIA AVE
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City | CHICAGO
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State | IL
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Zip | 60625-3661
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Country | US
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Telephone | 773-989-3800
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Fax | 773-907-1005
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Provider Business Mailing Address
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Address Line | 2000 SPRING RD SUITE 200
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City | OAK BROOK
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State | IL
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Zip | 60523-1804
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Country | US
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Telephone | 630-581-6507
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Fax |
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 036-115441
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License Number State | IL
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