MEDICARE: KEITH K NAM 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
1	207RP1001X	Pulmonary Disease Physician	036043256	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	21603529	OTHER	IL	BS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922180330
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEITH K NAM MD

Provider Business Mailing Address
First Line	:	3434 W PETERSON AVE
Second Line	:	SUITE 202
City	:	CHICAGO
State	:	IL
Zip	:	60659-3319
Country	:	US
Telephone Number	:	773-267-0781
Fax Number	:	773-267-0968

Provider Business Practice Location Address
First Line	:	3434 W PETERSON AVE
Second Line	:	SUITE 202
City	:	CHICAGO
State	:	IL
Zip	:	60659-3319
Country	:	US
Telephone Number	:	773-267-0781
Fax Number	:	773-267-0968

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

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	06/21/2011

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Directions to “ KEITH K NAM MD” Practice Location

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