Kirk, Kent Alan

Kirk, Kent Alan is an individual health care provider with primary practice located at 7427 Lake St , River Forest IL 60305-1817. He recently has only one registered license in Allopathic & Osteopathic Physicians / Ophthalmology, which is considered as his primary health care specialty. Kirk, Kent Alan can be contacted via phone (708) 771-3334.

Contact Information

Primary practice address
7427 Lake St River Forest IL 60305-1817
Phone: (708) 771-3334
Fax: (708) 771-9614
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Ophthalmology 207W00000X 036070489 Illinois

Profile Details

NPI number 1154340941
LBN Legal business name Kirk, Kent Alan
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 19th, 2006
Last updated Apr 4th, 2023 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1154340941 NPPES
Illinois Other 1607956 BC/BS ILLINOIS
Illinois Other 362658561 BC/BS ILLINOIS
Illinois MEDICAID 36070489 BC/BS ILLINOIS

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