MEDICARE: DR. KEVIN TODD HARRIS 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	208100000X	Physical Medicine & Rehabilitation Physician	036.128435	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P01116374	OTHER	IL	RR MEDICARE

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
2	036128435	OTHER	IL	LICENSE NO

General Provider Information

NPI Number	:	1588856405
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN TODD HARRIS M.D.

Provider Business Mailing Address
First Line	:	401 N MICHIGAN AVE
Second Line	:	SUITE 1200
City	:	CHICAGO
State	:	IL
Zip	:	60611-4264
Country	:	US
Telephone Number	:	312-635-0973
Fax Number	:	813-290-9691

Provider Business Practice Location Address
First Line	:	1525 OXFORD LN
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60565-1511
Country	:	US
Telephone Number	:	630-983-0300
Fax Number	:	630-983-9360

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

Provider Enumeration Date	:	08/14/2007
Last Update Date	:	10/29/2015

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