Provider Demographics
NPI:1326077942
Name:MCCUNE, KEVIN CRAIG (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:CRAIG
Last Name:MCCUNE
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 1:29373 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1293
Mailing Address - Country:US
Mailing Address - Phone:847-390-5900
Mailing Address - Fax:
Practice Address - Street 1:2000 SPRINGER DR
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-6402
Practice Address - Country:US
Practice Address - Phone:630-936-6800
Practice Address - Fax:630-829-1040
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036074226207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036074226Medicaid
ILCI19354OtherRR MEDICARE GROUP
IL080146274OtherRR MEDICARE PIN
ILCI19354OtherRR MEDICARE GROUP
IL080146274OtherRR MEDICARE PIN
IL036074226Medicaid
IL534410Medicare PIN
ILL69230Medicare PIN