Individual
KYLE EVERETT KISSICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5841 S MARYLAND AVE # MC3083, CHICAGO, IL 60637-1443
(773) 834-7708
Mailing address
180 HARVESTER DR STE 110, BURR RIDGE, IL 60527-6686
(773) 702-1150
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
125.073415
IL
Other
Enumeration date
07/29/2018
Last updated
07/29/2018
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