Provider Demographics
NPI:1447541214
Name:DAWSON, KYRA ANNE (DO)
Entity type:Individual
Prefix:DR
First Name:KYRA
Middle Name:ANNE
Last Name:DAWSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:836 W. WELLINGTON AVE
Mailing Address - Street 2:SUITE 4800
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-5147
Mailing Address - Country:US
Mailing Address - Phone:773-296-7465
Mailing Address - Fax:773-296-5570
Practice Address - Street 1:836 W. WELLINGTON AVE
Practice Address - Street 2:SUITE 4800
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657
Practice Address - Country:US
Practice Address - Phone:773-296-7465
Practice Address - Fax:773-296-7465
Is Sole Proprietor?:No
Enumeration Date:2011-04-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.1443275208600000X
OH34.011867208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0120293Medicaid
FD6741525OtherDEA NUMBER