# KEDZIE MEDICAL CLINIC INC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1558593947
- **Authorized official:** GOHAR AKOPYAN (CMM)
- **Authorized official phone:** (847) 904-7500

## Contact information

- **Practice address:** 262 N KEDZIE AVE, CHICAGO, IL 60612-1869
- **Practice address phone:** (847) 904-7500
- **Mailing address:** 262 N KEDZIE AVE, CHICAGO, IL 60612-1869

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QA0000X | Adolescent Medicine (Family Medicine) Physician | — | NULL | Yes |
| 207QA0000X | Adolescent Medicine (Family Medicine) Physician | — | — | Yes |

## Other

- **Enumeration date:** 08/18/2009
- **Last updated:** 08/18/2009