Kenny Bozorgi, M.D.

Primary specialty

Gynecologic Oncology PhysicianTaxonomy code 207VX0201X

License

036090621 Issued in IL

Practice address

409 W Huron St
Suite 301
Chicago, IL 60654-3431

Phone

(312) 787-7861

Fax

(312) 787-7916

NPI assigned

Jun 16, 2009

Last updated

Jun 16, 2009By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Southwestern Medical Center, LLC

  dba Magna Surgical Center

  • Ambulatory Surgical Clinic/Center
  • Bedford Park, IL
  • NPI 1790710390
  NPD Authorized official
• Partners in Surgical Care LLC

  • Surgery Physician
  • Oakbrook Terrace, IL
  • NPI 1033248927
  NPD (past) Authorized official
• Endeavor Health Medical Group

  dba NorthShore Anesthesia Group

  • Anesthesiology Physician
  • Evanston, IL
  • NPI 1265695944
  NPD (past)
• Endeavor Health Medical Group

  dba NorthShore University HealthSystem Faculty Practice Associates

  • Emergency Medicine Physician
  • Evanston, IL
  • NPI 1497701882
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1245110400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1245110400000",
    "number": "1255568333",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "409 W HURON ST",
            "address_2": "SUITE 301",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606543431",
            "telephone_number": "312-787-7861",
            "fax_number": "312-787-7916"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "409 W HURON ST",
            "address_2": "SUITE 301",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606543431",
            "telephone_number": "312-787-7861",
            "fax_number": "312-787-7916"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOZORGI",
        "first_name": "KENNY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-06-16",
        "last_updated": "2009-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207VX0201X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Gynecologic Oncology",
            "state": "IL",
            "license": "036090621",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PO85733J9",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Boys & Girls Club of Chicago - Robert R. McCormick Boys & Girls Club
• Mary Ellen Boyte, D.N.
• Christina M Bozarth, BS, IBCLC
• Stephen A. Bozek, M.D.
• Jenna Boznos, PHARMD
• BP Behavioral Services, LLC
• BR Psychiatry PLLC
• Braam Dental
• Braam-Hackney P.C.
• Lee S Braam, DMD

• Gynecologic Oncology Physician in Chicago, IL
• Providers in Chicago, IL by specialty
• Gynecologic Oncology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.