Provider Demographics
NPI:1508961517
Name:CLINE, KENNETH N (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:N
Last Name:CLINE
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 1:19550 GOVERNORS HWY
Mailing Address - Street 2:SUITE 2000
Mailing Address - City:FLOSSMOOR
Mailing Address - State:IL
Mailing Address - Zip Code:60422-2125
Mailing Address - Country:US
Mailing Address - Phone:708-957-8750
Mailing Address - Fax:708-957-8602
Practice Address - Street 1:19550 GOVERNORS HWY
Practice Address - Street 2:SUITE 2000
Practice Address - City:FLOSSMOOR
Practice Address - State:IL
Practice Address - Zip Code:60422-2125
Practice Address - Country:US
Practice Address - Phone:708-957-8750
Practice Address - Fax:708-957-8602
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL110163534/CA4448OtherRAILROAD PALMETTO GBA
ILK49612/203980Medicare PIN
K49611/203979Medicare PIN
IL110163534/CA4448OtherRAILROAD PALMETTO GBA
ILL66416Medicare ID - Type Unspecified