Individual
JOHN KINCINAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
2500 W REYNOLDS ST, PONTIAC, IL 61764-9774
(815) 844-4062
(815) 844-4962
Mailing address
2500 W REYNOLDS ST, PONTIAC, IL 61764-9774
(815) 844-4062
(815) 844-4962
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085002155
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5315769
BLUE CROSS BLUE SHIELD
—
Enumeration date
07/19/2006
Last updated
12/16/2013
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