Provider Demographics
NPI:1093821290
Name:MCCOYD, KEVIN (MD,FAAN)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:MCCOYD
Suffix:
Gender:M
Credentials:MD,FAAN
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 1348
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-8348
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:255 W 1ST ST
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-2643
Practice Address - Country:US
Practice Address - Phone:630-530-4449
Practice Address - Fax:630-530-4557
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2015-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-0544472084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036054447Medicaid
IL036054447Medicaid
ILP03864Medicare PIN