Provider Demographics
NPI:1316193162
Name:MYRIE, KEVIN ANDRE (MD,)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:ANDRE
Last Name:MYRIE
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 1:120 W 22ND ST STE 200
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1563
Mailing Address - Country:US
Mailing Address - Phone:630-573-5000
Mailing Address - Fax:630-491-5472
Practice Address - Street 1:90 W 86TH AVE
Practice Address - Street 2:NEPHROLOGY ASSOCIATES OF NORTHERN INDIANA
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-7086
Practice Address - Country:US
Practice Address - Phone:219-791-1555
Practice Address - Fax:219-791-1560
Is Sole Proprietor?:No
Enumeration Date:2008-08-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036123789207RN0300X
IN1071201A207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201077180Medicaid
INM400074806Medicare PIN