Provider Demographics
NPI:1619074713
Name:KINLAW, DENNIS F JR (MD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:F
Last Name:KINLAW
Suffix:JR
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:PO BOX 950244
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0244
Mailing Address - Country:US
Mailing Address - Phone:502-953-4799
Mailing Address - Fax:502-953-4798
Practice Address - Street 1:2500 W MARKET ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40212-1541
Practice Address - Country:US
Practice Address - Phone:502-778-8400
Practice Address - Fax:502-996-8309
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY19554207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000049537OtherBLUE CROSS FACET ID
KY0236404Medicare ID - Type Unspecified
KY000000049537OtherBLUE CROSS FACET ID