Individual
LOUIS KIENZLER GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
751 N RUTLEDGE ST, SUITE 3100, SPRINGFIELD, IL 62702-4968
(217) 545-8000
(217) 545-7393
Mailing address
751 N RUTLEDGE ST, PO BOX 19643, SPRINGFIELD, IL 62702-4968
(217) 545-8000
(217) 545-7393
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
036-142743
IL
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
036-142743
IL
Other
Enumeration date
06/26/2012
Last updated
10/23/2020
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