Provider Demographics
NPI:1437354966
Name:KIMBERLY RICAURTE, DO PLLC
Entity Type:Organization
Organization Name:KIMBERLY RICAURTE, DO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:RICAURTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-387-3918
Mailing Address - Street 1:421 N NORTHWEST HWY STE 4
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-6020
Mailing Address - Country:US
Mailing Address - Phone:847-387-3918
Mailing Address - Fax:847-387-3754
Practice Address - Street 1:421 N NORTHWEST HWY
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-6020
Practice Address - Country:US
Practice Address - Phone:847-387-3918
Practice Address - Fax:847-387-3754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-15
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036095603207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01633315OtherBLUE SHIELD OF ILLINOIS
IL01633315OtherBLUE SHIELD OF ILLINOIS