Organization
ROBERT S. KINSELLA, D.O.,S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT S KINSELLA D.O. (PRESIDENT)
(815) 220-8460
Entity
Organization
Contact information
Practice address
1631 4TH ST, PERU, IL 61354-3507
(815) 220-8460
(815) 220-8462
Mailing address
PO BOX 2, PERU, IL 61354-0002
(815) 220-8460
(815) 220-8462
Taxonomy
Speciality
Code
Description
License number
State
207VX0000X
Obstetrics Physician
Primary
036092375
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036092375
—
IL
01
—
05032051
BLUE CROSS BLUE SHIELD
IL
Enumeration date
05/02/2007
Last updated
07/10/2016
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