Provider Demographics
NPI:1508953258
Name:KINDRED, DAVID HENRY (MD)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:HENRY
Last Name:KINDRED
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 1:3230 VETERANS MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IL
Mailing Address - Zip Code:62864-5950
Mailing Address - Country:US
Mailing Address - Phone:618-997-5266
Mailing Address - Fax:618-997-5285
Practice Address - Street 1:3408 OFFICE PARK DR
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959
Practice Address - Country:US
Practice Address - Phone:618-997-5266
Practice Address - Fax:618-997-5285
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036086752207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036086752Medicaid
IL036086752Medicaid
IL204931Medicare PIN
F38935Medicare UPIN