Provider Demographics
NPI:1609936707
Name:KINDRED LLC
Entity Type:Organization
Organization Name:KINDRED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:H
Authorized Official - Last Name:KINDRED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:309-673-0000
Mailing Address - Street 1:120 NE GLEN OAK AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61603-4314
Mailing Address - Country:US
Mailing Address - Phone:309-673-0000
Mailing Address - Fax:309-673-3730
Practice Address - Street 1:120 NE GLEN OAK AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61603-4314
Practice Address - Country:US
Practice Address - Phone:309-673-0000
Practice Address - Fax:309-673-3730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL9032024OtherBLUE CROSS BLUE SHIELD
IL204931OtherPIN
IL9032024OtherBLUE CROSS BLUE SHIELD