Provider Demographics
NPI:1538101423
Name:BUSKIRK, JAMES KEVIN (PT)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:KEVIN
Last Name:BUSKIRK
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3545 LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-1058
Mailing Address - Country:US
Mailing Address - Phone:847-251-2028
Mailing Address - Fax:847-512-5064
Practice Address - Street 1:3545 LAKE AVE
Practice Address - Street 2:
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-1058
Practice Address - Country:US
Practice Address - Phone:847-251-2028
Practice Address - Fax:847-512-5064
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070004145174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL650007085OtherMEDICARE RAILROAD - PALMETTO GBA
IL200573902OtherTRANSIT REHABILITATION CENTERS OF CHICAGO
IL363396874OtherTAX ID PEAK THERAPEUTICS
IL01634372OtherBCBS GROUP NO.
ID1618443OtherBCBS IL GROUP ID
IL200573902OtherTAX ID BALANCE CTR OF IL
IL200573902OtherTRANSIT REHAB CENTERS OF CHICAGO
IL363396874OtherTAX ID PEAK THERAPEUTICS
ID1618443OtherBCBS IL GROUP ID
IL0296300002Medicare NSC
IL650007085OtherMEDICARE RAILROAD - PALMETTO GBA
IL200573902OtherTRANSIT REHABILITATION CENTERS OF CHICAGO