Provider Demographics
NPI:1699936674
Name:K MEDICAL, P.C.
Entity type:Organization
Organization Name:K MEDICAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNT
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:773-895-3668
Mailing Address - Street 1:7234 W NORTH AVE
Mailing Address - Street 2:#1712
Mailing Address - City:ELMWOOD PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60707-4239
Mailing Address - Country:US
Mailing Address - Phone:773-895-3668
Mailing Address - Fax:773-764-8650
Practice Address - Street 1:4501 W AUGUSTA BLVD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60651-3302
Practice Address - Country:US
Practice Address - Phone:773-252-4400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-23
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016-004758332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016004758Medicaid
01608372OtherBLUE CROSS
MO626167902Medicaid
480032514OtherRAILROAD MEDICARE
480032514OtherRAILROAD MEDICARE