Individual
KENNETH J DOLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1802 S. MATTIS AVENUE, ORTHOPEDICS, CHAMPAIGN, IL 61821
(217) 383-7676
(217) 383-4910
Mailing address
P.O. BOX 6002, URBANA, IL 61803-6002
(217) 326-8300
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
036067713
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0533210001
DMERC
IL
Enumeration date
07/17/2006
Last updated
06/05/2012
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