Individual
KENNETH PAUL MCDONNELL
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
203 W LOSEY ST, SUITE 1624, SCOTT AFB, IL 62225-5207
(618) 206-2225
Mailing address
1582 RYANNIE CT, O FALLON, IL 62269-6655
(618) 229-5496
(618) 229-0011
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01051889A
IN
Other
Enumeration date
09/16/2005
Last updated
07/08/2007
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