Provider Demographics
NPI:1720014673
Name:CULLINANE, KEVIN P (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:P
Last Name:CULLINANE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:7411 LAKE ST
Mailing Address - Street 2:SUITE 1120
Mailing Address - City:RIVER FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60305-1876
Mailing Address - Country:US
Mailing Address - Phone:708-488-1490
Mailing Address - Fax:708-488-2394
Practice Address - Street 1:7411 LAKE ST
Practice Address - Street 2:SUITE 1120
Practice Address - City:RIVER FOREST
Practice Address - State:IL
Practice Address - Zip Code:60305-1876
Practice Address - Country:US
Practice Address - Phone:708-488-1490
Practice Address - Fax:708-488-2394
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2022-05-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036-072179207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILE24576Medicare UPIN