Provider Demographics
NPI:1922101831
Name:MCMAHON, KIMBERLY (MD)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:
Last Name:MCMAHON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 N. KINGSBURY ST
Mailing Address - Street 2:SUITE 130N
Mailing Address - City:CHGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610
Mailing Address - Country:US
Mailing Address - Phone:312-775-1100
Mailing Address - Fax:312-775-1112
Practice Address - Street 1:900 N. KINGSBURY ST
Practice Address - Street 2:SUITE 130N
Practice Address - City:CHGO
Practice Address - State:IL
Practice Address - Zip Code:60610
Practice Address - Country:US
Practice Address - Phone:312-775-1100
Practice Address - Fax:312-775-1112
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-101114174400000X
IL036101114174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILH94986Medicare UPIN