Provider Demographics
NPI:1609142520
Name:KIRKWOOD, MARK KEVIN (DO)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:KEVIN
Last Name:KIRKWOOD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:MARK
Other - Middle Name:KEVIN
Other - Last Name:KIRKWOOD
Other - Suffix:II
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:12935 GREGORY ST
Mailing Address - Street 2:
Mailing Address - City:BLUE ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60406-2428
Mailing Address - Country:US
Mailing Address - Phone:708-597-2000
Mailing Address - Fax:
Practice Address - Street 1:12935 GREGORY ST
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:BLUE ISLAND
Practice Address - State:IL
Practice Address - Zip Code:60406-2428
Practice Address - Country:US
Practice Address - Phone:708-597-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-25
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.141200207P00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine