Individual
KENNETH ADAMS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
525 SWEETBRIAR DR, CHILLICOTHE, IL 61523
(309) 274-2102
Mailing address
5100 RELIABLE PKWY, CHICAGO, IL 60686-0001
(309) 672-4240
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
036071354
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
008863
HEALTH ALLIANCE
IL
05
—
0360713543
—
IL
01
—
472299
HEALTHLINK
IL
01
—
7215059
BCBS PPO
IL
01
—
970016346
MEDICARE RAILROAD
IL
01
—
IL01R7
JOHN DEERE
IL
Enumeration date
07/20/2006
Last updated
10/29/2009
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