Provider Demographics
NPI:1740376383
Name:KAM, ANTHONY WING-YUI (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:WING-YUI
Last Name:KAM
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2160 S. FIRST AVENUE
Mailing Address - Street 2:DEPT OF NEUROLOGICAL SURGERY
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153-3328
Mailing Address - Country:US
Mailing Address - Phone:708-216-3208
Mailing Address - Fax:
Practice Address - Street 1:2160 S. FIRST AVE
Practice Address - Street 2:DEPT OF NEUROLOGICAL SURGERY
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153-3328
Practice Address - Country:US
Practice Address - Phone:708-216-3208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2022-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD070661L2085R0204X
MDD00589552085R0204X
VA01012321192085R0204X
DCMD336632085R0204X
IL0361327542085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD018069600Medicaid
MD018069600Medicaid