Dr Kenneth William Park, DO is a medicare enrolled "Family Medicine" physician in Cary, Illinois. His current practice location is
125 Carlisle Ct, Cary, Illinois. You can reach out to his office (for appointments etc.) via phone at
(847) 639-1685.
Dr Kenneth William Park is licensed to practice in Illinois (license number 036055468) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1114928801.
Physician's Profile
Full Name | Dr Kenneth William Park |
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Gender | Male |
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Speciality | Family Medicine |
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Location | 125 Carlisle Ct, Cary, Illinois |
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Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
NPI Data:
- NPI Number: 1114928801
- Provider Enumeration Date: 08/03/2005
- Last Update Date: 08/13/2009
Medicare PECOS Information:
- PECOS PAC ID: 7911023056
- Enrollment ID: I20151124000504
Medical Identifiers
Medical identifiers for Dr Kenneth William Park such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1114928801 | NPI | - | NPPES |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
207Q00000X | Family Medicine | 036055468 (Illinois) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Kenneth William Park is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
Mailing Address | Practice Location Address |
Dr Kenneth William Park, DO 125 Carlisle Ct, Cary, IL 60013-1908 Ph: (847) 639-1685 | Dr Kenneth William Park, DO 125 Carlisle Ct, Cary, IL 60013-1908 Ph: (847) 639-1685 |
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