Provider Demographics
NPI:1598776494
Name:PHILIP, KJ (MD)
Entity Type:Individual
Prefix:DR
First Name:KJ
Middle Name:
Last Name:PHILIP
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Gender:M
Credentials:MD
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Mailing Address - Street 1:800 AUSTIN ST
Mailing Address - Street 2:WEST TOWER SUITE 607
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-3439
Mailing Address - Country:US
Mailing Address - Phone:847-475-6063
Mailing Address - Fax:847-475-6065
Practice Address - Street 1:2740 W FOSTER AVE.
Practice Address - Street 2:WEST TOWER SUITE 607
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-3439
Practice Address - Country:US
Practice Address - Phone:773-878-8200
Practice Address - Fax:773-293-4197
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2016-02-26
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Provider Licenses
StateLicense IDTaxonomies
IL036049083174400000X
IL036.049083207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL74226Medicare UPIN