Provider Demographics
NPI:1386616985
Name:KINNAS, SPERO JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:SPERO
Middle Name:JOHN
Last Name:KINNAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:10439 W CERMAK RD
Mailing Address - Street 2:
Mailing Address - City:WESTCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:60154-5237
Mailing Address - Country:US
Mailing Address - Phone:708-531-1030
Mailing Address - Fax:708-531-1078
Practice Address - Street 1:10439 W CERMAK RD
Practice Address - Street 2:
Practice Address - City:WESTCHESTER
Practice Address - State:IL
Practice Address - Zip Code:60154-5237
Practice Address - Country:US
Practice Address - Phone:708-531-1030
Practice Address - Fax:708-531-1078
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-071859207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC47540Medicare UPIN
IL746210Medicare ID - Type Unspecified