Provider Demographics
NPI:1437233632
Name:BARRIENTOS, JOEL KWAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:KWAN
Last Name:BARRIENTOS
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 1:1054 MARTIN LUTHER KING DRIVE
Mailing Address - Street 2:SUITE 121
Mailing Address - City:CENTRALIA
Mailing Address - State:IL
Mailing Address - Zip Code:62801-3065
Mailing Address - Country:US
Mailing Address - Phone:618-533-3222
Mailing Address - Fax:618-533-9606
Practice Address - Street 1:1054 MARTIN LUTHER KING DRIVE
Practice Address - Street 2:SUITE 121
Practice Address - City:CENTRALIA
Practice Address - State:IL
Practice Address - Zip Code:62801-3065
Practice Address - Country:US
Practice Address - Phone:618-533-3222
Practice Address - Fax:618-533-9606
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036069061208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0006100112OtherBLUE CROSS BLUE SHIELD
IL036069061Medicaid
IL0006100112OtherBLUE CROSS BLUE SHIELD
IL036069061Medicaid