Provider Demographics
NPI:1417983487
Name:KINSINGER, LEE T (MD)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:T
Last Name:KINSINGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 N CUMMINGS LN
Mailing Address - Street 2:P.O. BOX 369
Mailing Address - City:WASHINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61571-2181
Mailing Address - Country:US
Mailing Address - Phone:309-444-3627
Mailing Address - Fax:309-444-7158
Practice Address - Street 1:201 N CUMMINGS LN
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IL
Practice Address - Zip Code:61571-2181
Practice Address - Country:US
Practice Address - Phone:309-444-3627
Practice Address - Fax:309-444-7158
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-082346207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-082346Medicaid
ILE90653Medicare UPIN