Provider Demographics
NPI:1568531663
Name:KEARNS, JAMES MICHAEL JR (DN)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MICHAEL
Last Name:KEARNS
Suffix:JR
Gender:M
Credentials:DN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 E SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:IL
Mailing Address - Zip Code:60098-4247
Mailing Address - Country:US
Mailing Address - Phone:815-337-7109
Mailing Address - Fax:815-337-4619
Practice Address - Street 1:800 E SOUTH ST
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:IL
Practice Address - Zip Code:60098-4247
Practice Address - Country:US
Practice Address - Phone:815-337-7109
Practice Address - Fax:815-337-4619
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01625437OtherBLUE CROSS BLUE SHIELD