Provider Demographics
NPI:1487911459
Name:MACGILLIS, KYLE JOHN (MD)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:JOHN
Last Name:MACGILLIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7800 W COLLEGE DR
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-1007
Mailing Address - Country:US
Mailing Address - Phone:708-361-0600
Mailing Address - Fax:708-361-8710
Practice Address - Street 1:7600 W COLLEGE DR
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463
Practice Address - Country:US
Practice Address - Phone:708-361-0600
Practice Address - Fax:708-361-8710
Is Sole Proprietor?:No
Enumeration Date:2012-04-16
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036146032207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery