Individual
KEVIN BETHKE
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
676 N SAINT CLAIR ST, SUITE 1525A, CHICAGO, IL 60611-2927
(312) 943-2746
(312) 266-1411
Mailing address
PO BOX 388320, CHICAGO, IL 60638-8320
(773) 767-8283
(773) 767-8320
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01621690
BLUE SHIELD
IL
Enumeration date
09/30/2005
Last updated
07/08/2007
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