Individual
DR. KENT ALAN KIRK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7427 LAKE ST, RIVER FOREST, IL 60305-1817
(708) 771-3334
(708) 771-9614
Mailing address
7427 LAKE ST, RIVER FOREST, IL 60305-1817
(708) 771-3334
(708) 771-9614
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
036070489
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1607956
BC/BS ILLINOIS
IL
05
—
36070489
—
IL
01
—
362658561
FED TAX ID #
IL
Enumeration date
07/19/2006
Last updated
04/04/2023
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