Provider Demographics
NPI:1588035851
Name:KINNICK MEDICAL LIMITED
Entity Type:Organization
Organization Name:KINNICK MEDICAL LIMITED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:R
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-425-0400
Mailing Address - Street 1:17W725 BUTTERFIELD RD STE D
Mailing Address - Street 2:
Mailing Address - City:OAKBROOK TERRACE
Mailing Address - State:IL
Mailing Address - Zip Code:60181-4279
Mailing Address - Country:US
Mailing Address - Phone:630-656-1264
Mailing Address - Fax:773-305-0949
Practice Address - Street 1:17W725 BUTTERFIELD RD STE D
Practice Address - Street 2:
Practice Address - City:OAKBROOK TERRACE
Practice Address - State:IL
Practice Address - Zip Code:60181-4279
Practice Address - Country:US
Practice Address - Phone:630-656-1264
Practice Address - Fax:773-305-0949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-13
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL203.001676332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies