Individual
DR. KEVIN RENARD TEAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
611 W. PARK ST., NEUROSURGERY, URBANA, IL 61801-2500
(217) 383-3507
(217) 383-6006
Mailing address
611 W. PARK ST., BWPC, URBANA, IL 61801-2500
(217) 383-6792
(217) 383-6006
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
036134440
IL
207T00000X
Neurological Surgery Physician
29001
OK
207T00000X
Neurological Surgery Physician
J2368
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1613127-01
—
TX
05
—
200444140A
—
OK
Enumeration date
05/11/2006
Last updated
03/10/2015
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