Provider Demographics
NPI:1942280789
Name:KINSCHERFF, DAVID W (DPM)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:W
Last Name:KINSCHERFF
Suffix:
Gender:M
Credentials:DPM
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 340
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62062-0340
Mailing Address - Country:US
Mailing Address - Phone:618-344-4449
Mailing Address - Fax:618-344-4551
Practice Address - Street 1:122 E ZUPAN ST
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62062-2010
Practice Address - Country:US
Practice Address - Phone:618-344-4449
Practice Address - Fax:618-344-4551
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016004012213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000011510OtherMO MEDICARE GROUP
IL42690OtherGHP PIN#
MO135306OtherHEALTHLINK PIN#
MO16233OtherBC/BS OF MO - PIN#
IL2750017OtherUHC MIDWEST
IL480008235OtherRAILROAD MEDICARE PIN#
ILT38689Medicare UPIN
761790Medicare ID - Type UnspecifiedPROVIDER ID
MO16233OtherBC/BS OF MO - PIN#
IL2750017OtherUHC MIDWEST