Provider Demographics
NPI:1710066436
Name:KEDZIE MEDICAL ASSOCIATES,LTD
Entity Type:Organization
Organization Name:KEDZIE MEDICAL ASSOCIATES,LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:H
Authorized Official - Last Name:KYI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-423-6800
Mailing Address - Street 1:7960 SOUTH KEDZIE AVENUE
Mailing Address - Street 2:SUITE#2
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805
Mailing Address - Country:US
Mailing Address - Phone:708-423-6800
Mailing Address - Fax:708-423-0402
Practice Address - Street 1:9760 S KEDZIE AVE
Practice Address - Street 2:SUITE#2
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-3109
Practice Address - Country:US
Practice Address - Phone:708-423-6800
Practice Address - Fax:708-423-0402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center