Provider Demographics
NPI:1255449393
Name:RINKER, JOHN (DO)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:RINKER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 W REYNOLDS ST
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:IL
Mailing Address - Zip Code:61764-9673
Mailing Address - Country:US
Mailing Address - Phone:815-842-3381
Mailing Address - Fax:815-842-2861
Practice Address - Street 1:1515 W REYNOLDS ST
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:IL
Practice Address - Zip Code:61764-9673
Practice Address - Country:US
Practice Address - Phone:815-842-3381
Practice Address - Fax:815-842-2861
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036074643207P00000X, 207Q00000X
IN02002903A207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL5300107OtherBLUE CROSS BLUE SHIELD
IL036074643Medicaid
IL5300107OtherBLUE CROSS BLUE SHIELD
ILC43709Medicare UPIN