Provider Demographics
NPI:1356533269
Name:KITCHAROEN, KENZIE (MD)
Entity type:Individual
Prefix:
First Name:KENZIE
Middle Name:
Last Name:KITCHAROEN
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 1:899 SKOKIE BLVD SPC 333
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-4023
Mailing Address - Country:US
Mailing Address - Phone:847-834-1428
Mailing Address - Fax:855-265-2722
Practice Address - Street 1:899 SKOKIE BLVD SPC 333
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-4023
Practice Address - Country:US
Practice Address - Phone:847-834-1428
Practice Address - Fax:855-265-2722
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-14
Last Update Date:2021-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361245142084P0800X
IL036.1245142084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry