Healthcare Provider Details

I. General information

NPI: 1609936707
Provider Name (Legal Business Name): KINDRED LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 NE GLEN OAK AVE SUITE 200
PEORIA IL
61603-4314
US

IV. Provider business mailing address

120 NE GLEN OAK AVE SUITE 200
PEORIA IL
61603-4314
US

V. Phone/Fax

Practice location:
  • Phone: 309-673-0000
  • Fax: 309-673-3730
Mailing address:
  • Phone: 309-673-0000
  • Fax: 309-673-3730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID H KINDRED
Title or Position: PHYSICIAN
Credential: MD
Phone: 309-673-0000