Healthcare Provider Details

I. General information

NPI: 1982682530
Provider Name (Legal Business Name): JOSEPH E KINSKEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 01/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 U LN
DIKE IA
50624-9604
US

IV. Provider business mailing address

409 U LN
DIKE IA
50624-9604
US

V. Phone/Fax

Practice location:
  • Phone: 319-989-9324
  • Fax: 319-989-2957
Mailing address:
  • Phone: 319-989-9324
  • Fax: 319-989-2957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number32630
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number32630
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: