Basic Information
| Provider Information | |||||||||
| NPI: | 1972512853 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCKIAN | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | P | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3701 ALGONQUIN RD | ||||||||
| Address2: | STE 900 | ||||||||
| City: | ROLLING MEADOWS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600083127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8475770620 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3701 ALGONQUIN RD | ||||||||
| Address2: | STE 900 | ||||||||
| City: | ROLLING MEADOWS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600083127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8475770620 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2006 | ||||||||
| LastUpdateDate: | 12/20/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 48703 | MN | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RH0003X | 48703 | MN | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | 207RH0003X | 036-127475 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 701465000 | 05 | MN | MEDICAID | P00413287 | 01 | MN | MEDICARE RAILROAD | OTHER |