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Individual

KYLE SHEPPERSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
6810 STATE ROUTE 162, SUITE 10, MARYVILLE, IL 62062
(618) 288-2020
(618) 288-7983
Mailing address
6810 STATE ROUTE 162 BOX 215, MARYVILLE, IL 62062-8501
(618) 391-6405
(618) 288-4088

Taxonomy

Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
036108702
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
036108702
IL
Enumeration date
12/08/2005
Last updated
03/17/2020
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