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NPI Code Detail

MEDICARE: KEVIN LULOFS-MACPHERSON M.P.T.

MEDICARE: KEVIN LULOFS-MACPHERSON M.P.T.
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
1225100000XPhysical Therapist070-016346IL

General Provider Information

NPI Number : 1184729089
Entity Type Code : Individual
Provider Name (Legal Business Name) : KEVIN LULOFS-MACPHERSON M.P.T.
Provider Business Mailing Address
First Line : 790 REMINGTON BLVD
Second Line :
City : BOLINGBROOK
State : IL
Zip : 60440-4909
Country : US
Telephone Number : 813-298-2703
Fax Number : 831-910-8496
Provider Business Practice Location Address
First Line : 5616 W 63RD ST
Second Line :
City : CHICAGO
State : IL
Zip : 60638-5511
Country : US
Telephone Number : 773-526-5239
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/14/2006
Last Update Date : 07/07/2010

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