Kelvin Earl Wynn in Peoria - Family Medicine
Kelvin Earl Wynn - NPI 1104928639
Kelvin Earl Wynn is a Family Medicine in Peoria, Illinois. Kelvin Earl Wynn practices all healthcare services and medical treatments related to Family Medicine. The NPI Number for Kelvin Earl Wynn is 1104928639. The last update date is 2017-11-01.
Kelvin Earl Wynn's current location address is 815 Main St Ste A, Peoria, Illinois. You can contact this provider via phone number 3096724977. The mailing address for Kelvin Earl Wynn is 815 Main St Ste A, Peoria, Illinois. To know further, please read the information below!
Provider Profile Detail
| Provider Name | Kelvin Earl Wynn |
|---|---|
| Address | 815 Main St Ste A, Peoria, Illinois |
| Phone Number | 3096724977 |
| Fax Number | |
| Sole Proprietor | Y |
| Credentials | MD |
NPI Number Detail
| NPI Number | 1104928639 |
|---|---|
| Provider Enumeration Date | 2006-09-04 |
| Last Updated Date | 2017-11-01 |
Provider Mailing Address Detail
| Address | 815 Main St Ste A |
|---|---|
| City | Peoria |
| State | Illinois (IL) |
| Post Code | 616021080 |
| Phone Number | 3096724977 |
| Fax Number |
Provider's Primary Taxonomy Detail
| Speciality | Family Medicine |
|---|---|
| Taxonomy | 207Q00000X |
| Licence No | 34210 |
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Definition: Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine i |
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Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 36117956 | IL | LICENSE |
Post Comment/ Review Below
What is the unique identification code assigned to Kelvin Earl Wynn by the Centers for Medicare & Medicaid Services?
The Kelvin Earl Wynn has been issued the NPI (National Provider Identifier) 1104928639. This 10-digit code serves as a unique identifier for healthcare providers, assigned by the Centers for Medicare & Medicaid Services (CMS).
Could you please provide the complete street address where Kelvin Earl Wynn is physically located?
The Kelvin Earl Wynn is physically situated at the following address: 815 Main St Ste A, Peoria, IL, 616021080.
What is Kelvin Earl Wynn's specialized area of practice, and what is the corresponding taxonomy classification code for this field?
The Kelvin Earl Wynn's specialized field of practice is Family Medicine, and the corresponding taxonomy code that categorizes this area of specialization is 207Q00000X.
On what date did Kelvin Earl Wynn receive its 1104928639 assignment from the Centers for Medicare & Medicaid Services?
The Kelvin Earl Wynn was assigned its 1104928639 on 2006-09-04, which is the date when this unique identifier was issued to the organization by the Centers for Medicare & Medicaid Services.
As of what date was the information pertaining to Kelvin Earl Wynn, such as address, specialty, and other details, last reviewed and confirmed to be accurate?
The information related to Kelvin Earl Wynn, including its address, specialty, and other relevant details, was last reviewed and confirmed to be accurate on 2017-11-01.