MEDICARE: DR. RICHARD D. KERN M.D.

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	207RP1001X	Pulmonary Disease Physician	036063207	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053337758
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD D. KERN M.D.

Provider Business Mailing Address
First Line	:	2800 W 95TH ST
Second Line	:	PULMONARY MEDICINE CONSULTANTS, LTD.
City	:	EVERGREEN PARK
State	:	IL
Zip	:	60805-2701
Country	:	US
Telephone Number	:	708-424-9288
Fax Number	:

Provider Business Practice Location Address
First Line	:	2800 W 95TH ST
Second Line	:	PULMONARY MEDICINE CONSULTANTS, LTD.
City	:	EVERGREEN PARK
State	:	IL
Zip	:	60805-2701
Country	:	US
Telephone Number	:	708-424-9288
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	04/12/2011

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