Provider Demographics
NPI:1205885274
Name:TUNNAT, KEVIN JOHN (DPM)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:JOHN
Last Name:TUNNAT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 AUSTIN ST
Mailing Address - Street 2:SUITE #611
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-3439
Mailing Address - Country:US
Mailing Address - Phone:847-864-5010
Mailing Address - Fax:847-864-9632
Practice Address - Street 1:800 AUSTIN ST
Practice Address - Street 2:SUITE #611
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-3439
Practice Address - Country:US
Practice Address - Phone:847-864-5010
Practice Address - Fax:847-864-9632
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016004439213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016004439Medicaid
IL0449670001OtherDMERC/CEDI
IL60010790OtherBCBS
IL943100Medicare PIN
IL0449670001OtherDMERC/CEDI
IL60010790OtherBCBS
ILU12366Medicare UPIN