Basic Information
| Provider Information | |||||||||
| NPI: | 1619926409 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SILVIA | ||||||||
| FirstName: | KENNETH | ||||||||
| MiddleName: | ADDISON | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | II | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3308 GADWALL CT | ||||||||
| Address2: | |||||||||
| City: | SWANSEA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622268560 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6182335726 | ||||||||
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| Practice Location | |||||||||
| Address1: | 211 S 3RD ST | ||||||||
| Address2: | |||||||||
| City: | BELLEVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622201915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6182342120 | ||||||||
| FaxNumber: | 6186415810 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2006 | ||||||||
| LastUpdateDate: | 09/16/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | MD0000039070 | TN | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 26008 | SC | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 200100783 | NC | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 036.117031 | IL | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.