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1699125062
KENNETH JAMES MINIELLY
SPRINGFIELD, IL
NPI
1699125062
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
207N00000X Dermatology
(Licence: IL 125-068691)
Enumeration Date
2016-06-16
Last Update Date
2016-06-16
Business Address
-- KENNETH JAMES MINIELLY M.D.
751 N RUTLEDGE ST STE 2300
SPRINGFIELD, IL 62702-4968
Phone number: 217-545-8000
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Mailing Address
-- KENNETH JAMES MINIELLY M.D.
PO BOX 19644
SPRINGFIELD, IL 62794-9644
Phone number: 217-545-8000
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