Provider Demographics
NPI:1578566394
Name:KINNEY, MICHAEL R (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:R
Last Name:KINNEY
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 1:1700 W CENTRAL RD STE 50
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-2477
Mailing Address - Country:US
Mailing Address - Phone:847-797-9000
Mailing Address - Fax:847-797-9099
Practice Address - Street 1:1700 W CENTRAL RD STE 50
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-2477
Practice Address - Country:US
Practice Address - Phone:847-797-9000
Practice Address - Fax:847-797-9099
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036065367208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK13777Medicare ID - Type UnspecifiedINDIVIDUAL NUMBER
IL210735Medicare ID - Type UnspecifiedGROUP NUMBER
ILC43510Medicare UPIN