Provider Demographics
NPI:1154338697
Name:SCHLESINGER, KENNETH IRWIN (MD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:IRWIN
Last Name:SCHLESINGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61832-5100
Mailing Address - Country:US
Mailing Address - Phone:217-554-5448
Mailing Address - Fax:
Practice Address - Street 1:1900 E MAIN ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-5100
Practice Address - Country:US
Practice Address - Phone:217-554-5448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14466207L00000X
FLME54525207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC144668Medicaid
FLAE953ZOtherMEDICARE GTBA REASSIGN
FL07942OtherBCBS
FL5863129OtherAETNA GTBA
FL277909900Medicaid
C86333OtherUPIN
C86333OtherUPIN
SCC863330281Medicare ID - Type Unspecified
FL5863129OtherAETNA GTBA