Provider Demographics
NPI:1053337758
Name:KERN, RICHARD D (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:D
Last Name:KERN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2800 W 95TH ST
Mailing Address - Street 2:PULMONARY MEDICINE CONSULTANTS, LTD.
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-2701
Mailing Address - Country:US
Mailing Address - Phone:708-424-9288
Mailing Address - Fax:
Practice Address - Street 1:2800 W 95TH ST
Practice Address - Street 2:PULMONARY MEDICINE CONSULTANTS, LTD.
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-2701
Practice Address - Country:US
Practice Address - Phone:708-424-9288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036063207207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-063207Medicaid
C41656Medicare UPIN
IL036-063207Medicaid