Provider Demographics
NPI:1013064195
Name:FLINT, JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:FLINT
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 1:101 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:DELAVAN
Mailing Address - State:IL
Mailing Address - Zip Code:61734-9619
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:101 E 5TH ST
Practice Address - Street 2:
Practice Address - City:DELAVAN
Practice Address - State:IL
Practice Address - Zip Code:61734-9619
Practice Address - Country:US
Practice Address - Phone:309-696-2216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-112406208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics