Individual
KENNETH QUINLAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
5501 OLD YORK RD STE 1, PHILADELPHIA, PA 19141-3098
(800) 346-7834
Mailing address
5145 N CALIFORNIA AVE, CHICAGO, IL 60625-3661
(773) 989-3800
(773) 907-1005
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085008100
IL
363AM0700X
Medical Physician Assistant
MA060646
PA
Other
Enumeration date
07/12/2019
Last updated
01/25/2022
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