Provider Demographics
NPI:1932441771
Name:JOSEPH, KEVIN AUGUSTINE (MD)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:AUGUSTINE
Last Name:JOSEPH
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 1:440 N MCCLURG CT
Mailing Address - Street 2:APT #409
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-4370
Mailing Address - Country:US
Mailing Address - Phone:262-844-8559
Mailing Address - Fax:
Practice Address - Street 1:7110 W 127TH ST STE 130
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1579
Practice Address - Country:US
Practice Address - Phone:708-923-6300
Practice Address - Fax:708-923-6303
Is Sole Proprietor?:No
Enumeration Date:2013-03-19
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL036139732208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036139732Medicaid