Provider Demographics
NPI:1861768566
Name:SWONG, KEVIN NAKMUN (MD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:NAKMUN
Last Name:SWONG
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 1:259 E ERIE ST FL 13
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3926
Mailing Address - Country:US
Mailing Address - Phone:312-695-6800
Mailing Address - Fax:312-926-6600
Practice Address - Street 1:259 E ERIE ST FL 13
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3926
Practice Address - Country:US
Practice Address - Phone:312-695-8143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-27
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301117258207T00000X
IL036.152429207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery