Provider Demographics
NPI:1649294950
Name:GERMINO, KEVIN P (MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:P
Last Name:GERMINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 713260
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-1260
Mailing Address - Country:US
Mailing Address - Phone:630-469-9200
Mailing Address - Fax:
Practice Address - Street 1:16660 107TH ST
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-8898
Practice Address - Country:US
Practice Address - Phone:708-403-8500
Practice Address - Fax:708-364-7080
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036082588208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL705600OtherMEDICARE GROUP #
IL01630151OtherBCBS PROVIDER GROUP #
IL4205297OtherAETNA PROVIDER#
IL14D0991123OtherCLIA #
IL036082588Medicaid