Basic Information
| Provider Information | |||||||||
| NPI: | 1174519664 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KINSELLA-STALLTER | ||||||||
| FirstName: | PATRICIA | ||||||||
| MiddleName: | |||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2972 INDIAN TRAIL RD STE A | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605029408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6304990812 | ||||||||
| FaxNumber: | 6304990823 | ||||||||
| Practice Location | |||||||||
| Address1: | 2972 INDIAN TRAIL RD | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605029408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6304990812 | ||||||||
| FaxNumber: | 6304990823 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2005 | ||||||||
| LastUpdateDate: | 07/20/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 036-101480 | IL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.