Individual
DR. KELLY COLLEEN HIGGINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
374 E GRAND AVE # 6740, CARBONDALE, IL 62901-3962
(618) 453-3311
(618) 453-4449
Mailing address
PO BOX 19639, SPRINGFIELD, IL 62794-9639
(217) 545-8000
(844) 470-2486
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036118238
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036118238
STATE LICENSE
IL
05
—
036118238
—
IL
01
—
133586700
FEDERAL WORKERS COMP
IL
05
—
370966854002
—
IL
05
—
370966854005
—
IL
01
—
CF3444
MEDICARE RAILROAD
IL
Enumeration date
09/27/2005
Last updated
05/10/2024
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