Individual
KENNETH MAX EAKIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3 JUNCTION DR W, GLEN CARBON, IL 62034-2916
(618) 288-5088
(618) 288-9153
Mailing address
3 JUNCTION DR W, GLEN CARBON, IL 62034-2916
(618) 288-5088
(618) 288-9153
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036066196
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0107335
UNITED HEALTHCARE
—
05
—
036066196
—
IL
01
—
080021116
RR MEDICARE
IL
01
—
118802
HEALTHLINK
—
01
—
371205888
TAX ID
—
01
—
4622029
ADMINISTAR
IL
01
—
N4882
GROUP HEALTH PLAN
—
Enumeration date
06/22/2005
Last updated
04/30/2008
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