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NPI Code Detail

MEDICARE: KENNETH CANDIDO MD

MEDICARE: KENNETH CANDIDO MD
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
1208VP0014XInterventional Pain Medicine Physician36075131IL

Other Identifiers

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

General Provider Information

NPI Number : 1518937937
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENNETH CANDIDO MD
Provider Business Mailing Address
First Line : 509 RIDGEMOOR DR
Second Line :
City : WILLOWBROOK
State : IL
Zip : 60527-5358
Country : US
Telephone Number : 847-615-2200
Fax Number : 847-615-2858
Provider Business Practice Location Address
First Line : 836 W WELLINGTON AVE
Second Line : SUITE 4815
City : CHICAGO
State : IL
Zip : 60657-5147
Country : US
Telephone Number : 773-296-7934
Fax Number : 773-296-5088
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/26/2006
Last Update Date : 06/12/2014

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Directions to “ KENNETH CANDIDO MD” Practice Location

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