MEDICARE: KEVIN THOMAS LOUGHRY DO

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	207R00000X	Internal Medicine Physician	036-134753	IL

General Provider Information

NPI Number	:	1609190586
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN THOMAS LOUGHRY DO

Provider Business Mailing Address
First Line	:	29373 NETWORK PL
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60673-1293
Country	:	US
Telephone Number	:	847-390-5900
Fax Number	:

Provider Business Practice Location Address
First Line	:	4220 W 95TH ST
Second Line	:	STE 200
City	:	OAK LAWN
State	:	IL
Zip	:	60453-3072
Country	:	US
Telephone Number	:	708-398-0287
Fax Number	:	708-398-0281

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

Provider Enumeration Date	:	03/21/2010
Last Update Date	:	03/06/2025

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