Individual
DR. KENNETH W MIHELICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
535 ROXBURY RD, ROCKFORD, IL 61107-5076
(815) 398-0175
(815) 398-9587
Mailing address
535 ROXBURY RD, ROCKFORD, IL 61107-5076
(815) 398-0175
(815) 398-9587
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
036064793
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020015050
PALMETTO GBA RAILROAD MED
—
05
—
036064793
—
IL
Enumeration date
09/11/2006
Last updated
05/13/2015
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