MEDICARE: KC MEDICAL SERVICES, PC

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
1	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1053262790
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KC MEDICAL SERVICES, PC

Provider Business Mailing Address
First Line	:	191 N WACKER DR STE 1800
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60606-1631
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1215 LIVINGSTON AVE STE 6A
Second Line	:
City	:	NORTH BRUNSWICK
State	:	NJ
Zip	:	08902-3840
Country	:	US
Telephone Number	:	732-917-0600
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KRISTEN ANGELA MIRANDA
Credential	:	MD
Telephone Number	:	732-917-0600

Provider Enumeration Date	:	02/09/2026
Last Update Date	:	02/09/2026

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