Provider Demographics
NPI:1801860861
Name:KWAN, ANTHONY HILL (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:HILL
Last Name:KWAN
Suffix:
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 1:2570 24TH ST
Mailing Address - Street 2:STE124
Mailing Address - City:ROCK ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:61201-5394
Mailing Address - Country:US
Mailing Address - Phone:309-779-3670
Mailing Address - Fax:309-779-3675
Practice Address - Street 1:2570 24TH ST
Practice Address - Street 2:STE124
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201-5394
Practice Address - Country:US
Practice Address - Phone:309-779-3670
Practice Address - Fax:309-779-3675
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036094456208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
96232OtherBCWELLMARK
IL036094456001Medicaid
036094456OtherBCILLINOIS
4057E3OtherJOHN DEERE
362739299030OtherTRICARE
IA1801860861Medicaid
P00053774OtherRR MEDICARE
036094456OtherBCILLINOIS
4057E3OtherJOHN DEERE
G40201Medicare UPIN
P00053774OtherRR MEDICARE