Individual
DR. JOHN CHRIS KEFALAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2905 N MAIN ST, SUITE G, DECATUR, IL 62526-4276
(217) 425-2600
(217) 425-2900
Mailing address
2905 N MAIN ST, SUITE G, DECATUR, IL 62526-4276
(217) 425-2600
(217) 425-2900
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
36094691
IL
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
36094691
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
36-094691
—
IL
Enumeration date
10/10/2007
Last updated
02/13/2017
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