Provider Demographics
NPI:1346204518
Name:KINDER, CHARLES A (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:A
Last Name:KINDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13011 S 104TH AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:PALOS PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60464-1508
Mailing Address - Country:US
Mailing Address - Phone:708-478-3600
Mailing Address - Fax:708-478-3552
Practice Address - Street 1:3231 EUCLID AVE STE 201
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-3472
Practice Address - Country:US
Practice Address - Phone:708-783-2055
Practice Address - Fax:708-783-2181
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036083033207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01621208OtherBLUECROSS BLUE SHIELD
IL036083033Medicaid
IL416810OtherMEDICARE GROUP
IL060071228OtherRAILROAD MEDICARE KANKAKE
ILCN2703OtherRAILROAD MEDICARE GROUP PTAN NUMBER
IL236550OtherMEDICARE GROUP
IL236551OtherMEDICARE GROUP
IL060071226OtherRAILROAD MEDICARE COOK
IL060071227OtherRAILROAD MEDICARE WILL
IL1508810086OtherGROUP NPI
ILCD8033OtherRAILROAD MEDICARE GROUP PTAN NUMBER
ILCG1672OtherRAILROAD MEDICARE GROUP PTAN NUMBER
IL060071227OtherRAILROAD MEDICARE WILL
IL236550OtherMEDICARE GROUP
IL416810OtherMEDICARE GROUP
ILCD8033OtherRAILROAD MEDICARE GROUP PTAN NUMBER