Provider Demographics
NPI:1245222165
Name:FINKELSTEIN, KENNETH (DO)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:
Last Name:FINKELSTEIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10260 191ST ST
Mailing Address - Street 2:STE. 100
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-8801
Mailing Address - Country:US
Mailing Address - Phone:708-425-1907
Mailing Address - Fax:708-469-4358
Practice Address - Street 1:10260 191ST ST
Practice Address - Street 2:STE. 100
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-8801
Practice Address - Country:US
Practice Address - Phone:708-425-1907
Practice Address - Fax:708-469-4358
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-17
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036089089207V00000X, 2088F0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2088F0040XAllopathic & Osteopathic PhysiciansUrologyFemale Pelvic Medicine and Reconstructive Surgery
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036089089Medicaid
ILF400177928Medicare PIN
IL036089089Medicaid