Provider Demographics
NPI:1427335884
Name:KINSINGER, KENNETH DANIEL
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:DANIEL
Last Name:KINSINGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 E HOLLAND ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61571-2636
Mailing Address - Country:US
Mailing Address - Phone:309-231-4973
Mailing Address - Fax:
Practice Address - Street 1:2324 W WAR MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-5552
Practice Address - Country:US
Practice Address - Phone:309-685-5209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-12
Last Update Date:2011-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.295084183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist