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NPI Code Detail

MEDICARE: REJUV DAVID KINDRED, PC

MEDICARE: REJUV DAVID KINDRED, PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207V00000XObstetrics & Gynecology PhysicianIL

General Provider Information

NPI Number : 1093062077
Entity Type Code : Organization
Provider Name (Legal Business Name) : REJUV DAVID KINDRED, PC
Provider Business Mailing Address
First Line : 2806 N KNOXVILLE AVE
Second Line :
City : PEORIA
State : IL
Zip : 61604-2870
Country : US
Telephone Number : 309-214-9950
Fax Number :
Provider Business Practice Location Address
First Line : 2806 N KNOXVILLE AVE
Second Line :
City : PEORIA
State : IL
Zip : 61604-2870
Country : US
Telephone Number : 309-214-9950
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DR. DAVID KINDRED
Credential : MD
Telephone Number : 309-214-9950
Provider Enumeration Date : 08/09/2012
Last Update Date : 08/09/2012

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