Provider Demographics
NPI:1619926409
Name:SILVIA, KENNETH ADDISON II (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:ADDISON
Last Name:SILVIA
Suffix:II
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 1:3308 GADWALL CT
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:IL
Mailing Address - Zip Code:62226-8560
Mailing Address - Country:US
Mailing Address - Phone:618-233-5726
Mailing Address - Fax:
Practice Address - Street 1:211 S 3RD ST
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62220-1915
Practice Address - Country:US
Practice Address - Phone:618-234-2120
Practice Address - Fax:618-641-5810
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000039070207L00000X
SC26008207L00000X
NC200100783207L00000X
IL036.117031207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H46447Medicare UPIN
TN3325759Medicare ID - Type Unspecified