Provider Demographics
NPI:1760450894
Name:FRANKE, KEVIN JOSEPH (PHD)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:JOSEPH
Last Name:FRANKE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 SIMPSON ST
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-3118
Mailing Address - Country:US
Mailing Address - Phone:312-920-1992
Mailing Address - Fax:312-263-2530
Practice Address - Street 1:20 N WACKER DR
Practice Address - Street 2:SUITE 1931
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60606-2806
Practice Address - Country:US
Practice Address - Phone:312-920-1992
Practice Address - Fax:312-263-2530
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071003748103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL924940Medicare ID - Type UnspecifiedMECICARE PROVIDER NUMBER