Individual
BRYAN J. KELLENBERGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
400 SAINT JOHNS DR, SHERMAN, IL 62684-9779
(217) 528-7541
(217) 525-0044
Mailing address
1025 S 6TH ST, SPRINGFIELD, IL 62703-2403
(217) 528-7541
(217) 525-0044
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036125353
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036125353
—
IL
Enumeration date
07/19/2007
Last updated
05/21/2020
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