Provider Demographics
NPI:1114214236
Name:KIM, AARON K (DPM)
Entity type:Individual
Prefix:
First Name:AARON
Middle Name:K
Last Name:KIM
Suffix:
Gender:M
Credentials:DPM
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 25672
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-2007
Mailing Address - Country:US
Mailing Address - Phone:630-418-6601
Mailing Address - Fax:866-512-8061
Practice Address - Street 1:396 REMINGTON BLVD STE 141
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-4306
Practice Address - Country:US
Practice Address - Phone:630-418-6601
Practice Address - Fax:866-512-8061
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-10
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016005533213ES0103X
IL135000750213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty