Provider Demographics
NPI:1982022810
Name:SHEPARD, KIRK VAN II (MD, MS)
Entity Type:Individual
Prefix:DR
First Name:KIRK
Middle Name:VAN
Last Name:SHEPARD
Suffix:II
Gender:M
Credentials:MD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 N HALSTED ST STE 400
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-8480
Mailing Address - Country:US
Mailing Address - Phone:773-296-5500
Mailing Address - Fax:773-296-3800
Practice Address - Street 1:3000 N HALSTED ST STE 400
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-8480
Practice Address - Country:US
Practice Address - Phone:773-296-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-28
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.151294207R00000X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine