Individual
KYLE T CUMMISFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1000 N WESTMORELAND RD, LAKE FOREST, IL 60045-1658
(847) 234-5600
Mailing address
1000 N WESTMORELAND RD, LAKE FOREST, IL 60045-1658
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
—
—
363AM0700X
Medical Physician Assistant
Primary
085006665
IL
Other
Enumeration date
06/18/2018
Last updated
05/09/2022
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