Provider Demographics
NPI:1053844142
Name:KUCUK, KEMAL
Entity type:Individual
Prefix:
First Name:KEMAL
Middle Name:
Last Name:KUCUK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 N MILWAUKEE AVE UNIT 262
Mailing Address - Street 2:
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-1659
Mailing Address - Country:US
Mailing Address - Phone:706-506-6870
Mailing Address - Fax:
Practice Address - Street 1:1111 N MILWAUKEE AVE UNIT 262
Practice Address - Street 2:
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-1659
Practice Address - Country:US
Practice Address - Phone:706-506-6870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-06
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI72984207R00000X, 208M00000X
IL036.164855207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist