Basic Information
| Provider Information | |||||||||
| NPI: | 1679527998 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KINN | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | WILLIAM | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 414 DIVISION ST | ||||||||
| Address2: | |||||||||
| City: | SUGAR GROVE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605545109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6302320280 | ||||||||
| FaxNumber: | 6303151005 | ||||||||
| Practice Location | |||||||||
| Address1: | 25 NORTH WINFIELD ROAD | ||||||||
| Address2: | NORTH ENTRANCE | ||||||||
| City: | WINFIELD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60190 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6305109244 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2006 | ||||||||
| LastUpdateDate: | 02/17/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0011X | 036093128 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
ID Information
| ID | Type | State | Issuer | Description | 036093128 | 05 | IL | MEDICAID | F400139324 | 01 | IL | MEDICARE PTAN (INDIVIDUAL) | OTHER | 206147 | 01 | IL | MEDICARE PTAN (GROUP) | OTHER | P01345532 | 01 | IL | MEDICARE RAILROAD (INDIVIDUAL) | OTHER | CA4748 | 01 | IL | MEDICARE RAILROAD (GROUP) | OTHER |