Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0200X | Radiology | IL | |
Y | 213ER0200X | Radiology | IL |
NPI | 1447472303 |
---|---|
Provider Name | Brian Richard Kincaid |
First Address | Frankfort, IL 60423-9589 |
Second Address | Frankfort, IL 60423-9589 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2007 |
Last Update Date | 08/07/2007 |