Provider Demographics
NPI:1134426539
Name:BERMAN, KEVIN (MD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:BERMAN
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 1:515 S MAPLEWOOD AVE
Mailing Address - Street 2:4 NORTH
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3471
Mailing Address - Country:US
Mailing Address - Phone:303-475-4717
Mailing Address - Fax:
Practice Address - Street 1:515 S MAPLEWOOD AVE
Practice Address - Street 2:4 NORTH
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3471
Practice Address - Country:US
Practice Address - Phone:303-475-4717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-21
Last Update Date:2011-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.126086208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery