Individual
EVEN C KVELLAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
600 N COLLEGE AVE, SUITE 120, GENESEO, IL 61254-1091
(309) 946-5124
(309) 721-1407
Mailing address
600 N COLLEGE AVE, SUITE 120, GENESEO, IL 61254-1091
(309) 946-5124
(309) 721-1407
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036051263
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036051263
—
IL
05
—
0360512632
—
IL
01
—
110228695
RR MEDICARE
IL
05
—
1467430025
—
IL
Enumeration date
01/04/2006
Last updated
01/15/2014
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