Provider Demographics
NPI:1730114612
Name:ASBURY, JOSEPH KENYON (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:KENYON
Last Name:ASBURY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1229 N NORTH BRANCH ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642-2473
Mailing Address - Country:US
Mailing Address - Phone:312-030-5090
Mailing Address - Fax:312-640-4496
Practice Address - Street 1:1229 N NORTH BRANCH ST
Practice Address - Street 2:SUITE 206
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-2473
Practice Address - Country:US
Practice Address - Phone:312-939-5090
Practice Address - Fax:312-640-4496
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL114324207R00000X
IL036114324207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine