Provider Demographics
NPI:1558345934
Name:COLLINS, KEVIN P (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:P
Last Name:COLLINS
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 1:801 S WASHINGTON ST
Mailing Address - Street 2:EMERGENCY SERVICES ADMINISTRATION
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-7430
Mailing Address - Country:US
Mailing Address - Phone:630-527-5144
Mailing Address - Fax:630-548-7762
Practice Address - Street 1:801 S WASHINGTON ST
Practice Address - Street 2:EMERGENCY SERVICES ADMINISTRATION
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-7430
Practice Address - Country:US
Practice Address - Phone:630-527-5144
Practice Address - Fax:630-548-7762
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO41764207P00000X
IN01054196A207P00000X
IL0036-098097207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO14433842Medicaid
CO504088Medicare ID - Type Unspecified
COH41024Medicare UPIN