Individual
KEHINDE M GANIYU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3333 W DEYOUNG ST, MARION, IL 62959-5884
(618) 998-7000
Mailing address
4750 HEMPSTEAD STATION DR, KETTERING, OH 45429-5164
(800) 875-0136
(937) 619-4231
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
036068226
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036068226-1
—
IL
05
—
036068226-7
—
IL
01
—
3932056
BLUE SHIELD
IL
Enumeration date
05/04/2006
Last updated
02/02/2009
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