Provider Demographics
NPI:1538261151
Name:RICAURTE, KIMBERLY KAY (DO)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:KAY
Last Name:RICAURTE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:570 LINCOLN AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:WINNETKA
Mailing Address - State:IL
Mailing Address - Zip Code:60093-2355
Mailing Address - Country:US
Mailing Address - Phone:847-441-5700
Mailing Address - Fax:847-441-5167
Practice Address - Street 1:570 LINCOLN AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:WINNETKA
Practice Address - State:IL
Practice Address - Zip Code:60093-2355
Practice Address - Country:US
Practice Address - Phone:847-441-5700
Practice Address - Fax:847-441-5167
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-03
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036095603207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036095603Medicaid
ILK51175Medicare PIN
IL036095603Medicaid