Provider Demographics
NPI:1144258781
Name:KERN, KEVIN PATRICK (DO)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:PATRICK
Last Name:KERN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1792 S RANDALL RD
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-4602
Mailing Address - Country:US
Mailing Address - Phone:630-425-0800
Mailing Address - Fax:630-425-0799
Practice Address - Street 1:1792 S RANDALL RD
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-4602
Practice Address - Country:US
Practice Address - Phone:630-425-0800
Practice Address - Fax:630-425-0799
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036101395202K00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebology
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL79510OtherGROUP MEDICARE PTAN
IL789511OtherGROUP MEDICARE PTAN
ILF400323151Medicare PIN
IL789511OtherGROUP MEDICARE PTAN
ILF400323152Medicare PIN