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NPI Code Detail

MEDICARE: MK MEDICAL GROUP LLC

MEDICARE: MK MEDICAL GROUP LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician036111568IL

General Provider Information

NPI Number : 1013236090
Entity Type Code : Organization
Provider Name (Legal Business Name) : MK MEDICAL GROUP LLC
Provider Business Mailing Address
First Line : 1130 N DEARBORN ST
Second Line : 704
City : CHICAGO
State : IL
Zip : 60610-2756
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5729 W CERMAK RD
Second Line :
City : CICERO
State : IL
Zip : 60804-2129
Country : US
Telephone Number : 708-477-6525
Fax Number :
Authorized Official
Title or Position : OWNER
Name : MILENA KYOUTCHOUKOVA
Credential : M.D.
Telephone Number : 708-691-1429
Provider Enumeration Date : 05/31/2010
Last Update Date : 11/01/2011

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Directions to “MK MEDICAL GROUP LLC ” Practice Location

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