Provider Demographics
NPI:1689803462
Name:KANNIN MEDICAL GROUP S.C.
Entity Type:Organization
Organization Name:KANNIN MEDICAL GROUP S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:KANNIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-647-1771
Mailing Address - Street 1:6954 W TOUHY AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-4535
Mailing Address - Country:US
Mailing Address - Phone:847-647-1771
Mailing Address - Fax:847-647-5981
Practice Address - Street 1:6954 W TOUHY AVE STE 101
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-4535
Practice Address - Country:US
Practice Address - Phone:847-647-1771
Practice Address - Fax:847-647-5981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-14
Last Update Date:2020-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036086448207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty