Provider Demographics
NPI:1790724045
Name:RESNICK, KENNETH I (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:I
Last Name:RESNICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 E BRUSH HILL RD STE 300
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-5659
Mailing Address - Country:US
Mailing Address - Phone:630-571-1501
Mailing Address - Fax:630-571-5679
Practice Address - Street 1:133 E BRUSH HILL RD STE 300
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-5659
Practice Address - Country:US
Practice Address - Phone:630-571-1501
Practice Address - Fax:630-571-5679
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.074927207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL180009836OtherRR MEDICARE PIN
IL180040537OtherRR MEDICARE PIN
IL036074927Medicaid
IL2201714OtherBCBS
IL180009836OtherRR MEDICARE PIN
IL928942Medicare PIN
IL2201714OtherBCBS
IL928943Medicare PIN