Provider Demographics
NPI:1285724997
Name:AMIN, KIRAN P (MD)
Entity type:Individual
Prefix:
First Name:KIRAN
Middle Name:P
Last Name:AMIN
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 1:4211 N CICERO
Mailing Address - Street 2:STE 201
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641
Mailing Address - Country:US
Mailing Address - Phone:773-481-1001
Mailing Address - Fax:773-481-0904
Practice Address - Street 1:4211 N CICERO
Practice Address - Street 2:STE 201
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641
Practice Address - Country:US
Practice Address - Phone:773-481-1001
Practice Address - Fax:773-481-0904
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
605242Medicare ID - Type Unspecified
C43654Medicare UPIN