Provider Demographics
NPI:1033182795
Name:KIM, MICHAEL HYUN-OOK (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:HYUN-OOK
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7500 MERCY RD
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-2319
Mailing Address - Country:US
Mailing Address - Phone:402-398-5880
Mailing Address - Fax:402-398-6716
Practice Address - Street 1:747 N RUTLEDGE ST
Practice Address - Street 2:5TH FLOOR
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-6700
Practice Address - Country:US
Practice Address - Phone:217-545-8000
Practice Address - Fax:217-545-7063
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD14035207RC0001X
NE31083207RC0000X
IL036-105331207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN393667800Medicaid
ILIL4720012OtherMEDICARE PROVIDER NUMBER-LAKE COUNTY
ILK30600OtherMEDICARE PROVIDER NUMBER
IL036105331Medicaid
MN393667800Medicaid