Individual
DR. T RANDALL KINSELLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
917 SHERWOOD DR, LAKE BLUFF, IL 60044-2203
(847) 295-1220
(847) 295-1227
Mailing address
917 SHERWOOD DR, LAKE BLUFF, IL 60044-2203
(847) 295-1220
(847) 295-1227
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
36069577
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
36069577
—
IL
Enumeration date
06/12/2006
Last updated
04/14/2015
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