Individual
OCTAVIA KINCAID
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1000 CENTRAL ST STE 880, EVANSTON, IL 60201-1780
(847) 570-2570
Mailing address
2650 RIDGE AVE STE 1223, EVANSTON, IL 60201-1700
(847) 570-2040
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
036-109346
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036109346
STATE LICENSE
IL
Enumeration date
05/17/2007
Last updated
03/11/2021
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