Provider Demographics
NPI:1972512853
Name:MCKIAN, KEVIN P
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:P
Last Name:MCKIAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 ALGONQUIN RD
Mailing Address - Street 2:STE 900
Mailing Address - City:ROLLING MEADOWS
Mailing Address - State:IL
Mailing Address - Zip Code:60008-3127
Mailing Address - Country:US
Mailing Address - Phone:847-577-0620
Mailing Address - Fax:
Practice Address - Street 1:3701 ALGONQUIN RD
Practice Address - Street 2:STE 900
Practice Address - City:ROLLING MEADOWS
Practice Address - State:IL
Practice Address - Zip Code:60008-3127
Practice Address - Country:US
Practice Address - Phone:847-577-0620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN48703207R00000X, 207RH0003X
IL036-127475207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN701465000Medicaid
MNP00413287OtherMEDICARE RAILROAD
IL698760001Medicare PIN
IL698763001Medicare PIN
MN701465000Medicaid
MN110010822Medicare PIN