Provider Demographics
NPI:1235691809
Name:LONDE, KEVIN S (DO)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:S
Last Name:LONDE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3428
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62708-3428
Mailing Address - Country:US
Mailing Address - Phone:217-732-9681
Mailing Address - Fax:217-735-6527
Practice Address - Street 1:515 N COLLEGE ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:IL
Practice Address - Zip Code:62656-1401
Practice Address - Country:US
Practice Address - Phone:217-732-9681
Practice Address - Fax:217-735-6527
Is Sole Proprietor?:No
Enumeration Date:2019-04-03
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.165305207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036.165305OtherDO LICENSE