Healthcare Provider Details

I. General information

NPI: 1477551638
Provider Name (Legal Business Name): ROBERT C KINCADE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 10/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 L ST FL 6
SACRAMENTO CA
95816-5616
US

IV. Provider business mailing address

PO BOX 255228
SACRAMENTO CA
95865-5228
US

V. Phone/Fax

Practice location:
  • Phone: 916-887-4845
  • Fax: 916-887-4075
Mailing address:
  • Phone: 800-470-0071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberA65669
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: