# KINGDOM LIVING HEALTHCARE SC

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

## Provider details

- **NPI number:** 1720021496
- **Authorized official:** ANTHONY L BUCKLES MD (CEO)
- **Authorized official phone:** (773) 445-0292

## Contact information

- **Practice address:** 1701 W MONTEREY AVE, SUITE 1, CHICAGO, IL 60643-4257
- **Practice address phone:** (773) 445-0292
- **Mailing address:** 1701 W MONTEREY AVE, SUITE 1, CHICAGO, IL 60643-4257
- **Mailing address phone:** (773) 445-0292

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | IL | — |
| 207R00000X | Internal Medicine Physician | — | IL | Yes |
| 207T00000X | Neurological Surgery Physician | — | IL | — |
| 208000000X | Pediatrics Physician | — | IL | — |

## Other

- **Enumeration date:** 06/13/2006
- **Last updated:** 09/11/2025