Individual
KELLY HUNT HALLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
912 N HENRIETTA ST, EFFINGHAM, IL 62401-1788
(217) 342-3337
(217) 342-3338
Mailing address
PO BOX 784, EFFINGHAM, IL 62401-0784
(217) 342-3337
(217) 342-3338
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
036-086663
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036086663
—
IL
Enumeration date
09/21/2005
Last updated
03/07/2017
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