Provider Demographics
NPI:1740291780
Name:CHEN, KEVIN C (MD)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:C
Last Name:CHEN
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:PO BOX 1887
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959
Mailing Address - Country:US
Mailing Address - Phone:618-997-8412
Mailing Address - Fax:618-997-3726
Practice Address - Street 1:3405 OFFICE PARK DR
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-6478
Practice Address - Country:US
Practice Address - Phone:618-997-8412
Practice Address - Fax:618-997-3726
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN36108368207R00000X
IL036108368207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01635188OtherBCBS
IL036108368OtherILLINOIS LICENSE
IL036108368Medicaid
IL104897OtherHEALTH ALLIANCE
IL036108368Medicaid