Healthcare Provider Details

I. General information

NPI: 1104888486
Provider Name (Legal Business Name): JOHN KWINN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2640 W 183 ST
HOMEWOOD IL
60430
US

IV. Provider business mailing address

2640 W 183 ST
HOMEWOOD IL
60430
US

V. Phone/Fax

Practice location:
  • Phone: 708-798-6633
  • Fax: 708-798-6790
Mailing address:
  • Phone: 708-798-6633
  • Fax: 708-798-6790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: