Individual
KENNETH JAMES MINIELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
751 N RUTLEDGE ST STE 2300, SPRINGFIELD, IL 62702-4968
(217) 545-8000
(217) 545-7438
Mailing address
PO BOX 19644, SPRINGFIELD, IL 62794-9644
(217) 545-8000
(217) 545-7438
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
125-068691
IL
Other
Enumeration date
06/16/2016
Last updated
06/16/2016
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