Provider Demographics
NPI:1417911900
Name:KINSELLA, ROBERT S (DO)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:S
Last Name:KINSELLA
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:PO BOX 2
Mailing Address - Street 2:
Mailing Address - City:PERU
Mailing Address - State:IL
Mailing Address - Zip Code:61354-0002
Mailing Address - Country:US
Mailing Address - Phone:815-220-8460
Mailing Address - Fax:815-220-8462
Practice Address - Street 1:1631 4TH ST
Practice Address - Street 2:
Practice Address - City:PERU
Practice Address - State:IL
Practice Address - Zip Code:61354-3507
Practice Address - Country:US
Practice Address - Phone:815-220-8460
Practice Address - Fax:815-220-8462
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2016-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-092375207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL05032051OtherBLUE CROSS BLUE SHIELD IL
IL036092375Medicaid
IL05032051OtherBLUE CROSS BLUE SHIELD IL
ILF67802Medicare UPIN