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General NPI Number Information
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NPI Number | 1225266984
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Entity Type | Organization
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Legal Business Name | PANDURANGA R KINI MD, LTD
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Dates
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Enumeration Date | 07/01/2009
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Last Update Date | 10/06/2009
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Provider Practice Location Address
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Address Line | 7 PARK PL STE A
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City | SWANSEA
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State | IL
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Zip | 62226-2916
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Country | US
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Telephone | 618-233-1151
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Fax | 618-235-1079
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Provider Business Mailing Address
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Address Line | 7 PARK PLACE STE A
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City | SWANSEA
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State | IL
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Zip | 62226-2916
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Country | US
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Telephone | 618-233-1151
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Fax | 618-235-1079
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Authorized Official
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Title or Position | OWNER
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Name | DR. PANDURANGA R KINI
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Credential | MD
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Telephone | 618-233-1151
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 036064310
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License Number State | IL
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