Provider Demographics
NPI:1588856405
Name:HARRIS, KEVIN TODD (MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:TODD
Last Name:HARRIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:401 N MICHIGAN AVE
Mailing Address - Street 2:SUITE 1200
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-4264
Mailing Address - Country:US
Mailing Address - Phone:312-635-0973
Mailing Address - Fax:813-290-9691
Practice Address - Street 1:1525 OXFORD LN
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60565-1511
Practice Address - Country:US
Practice Address - Phone:630-983-0300
Practice Address - Fax:630-983-9360
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-14
Last Update Date:2015-10-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036.128435208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036128435Medicaid
IL036128435OtherLICENSE NO
ILP01116374OtherRR MEDICARE
IL036128435Medicaid