Organization
PANDURANGA R KINI MD, LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PANDURANGA R KINI MD (OWNER)
(618) 233-1151
Entity
Organization
Contact information
Practice address
7 PARK PL STE A, SWANSEA, IL 62226-2916
(618) 233-1151
(618) 235-1079
Mailing address
7 PARK PLACE, STE A, SWANSEA, IL 62226-2916
(618) 233-1151
(618) 235-1079
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
036064310
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036064310
—
IL
01
—
08200528
BCBS
—
01
—
100708
HEALTHLINK
IL
01
—
130000629
RR MEDICARE
IL
01
—
34490
GHP
—
01
—
4000537
AETNA
IL
Enumeration date
07/01/2009
Last updated
10/06/2009
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