Provider Demographics
NPI:1578632675
Name:KINGSTON, RODNEY (MD)
Entity Type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:
Last Name:KINGSTON
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 1:2570 FEDERAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526
Mailing Address - Country:US
Mailing Address - Phone:217-872-1003
Mailing Address - Fax:217-233-4150
Practice Address - Street 1:2570 FEDERAL DRIVE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526
Practice Address - Country:US
Practice Address - Phone:217-872-1003
Practice Address - Fax:217-233-4150
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360614422084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL05821971OtherBCBS
IL260046744OtherRR MEDICARE
IL05821971OtherBCBS
H32907Medicare UPIN