Individual
DR. KEVIN GREGORY NEILL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D., M.P.H.
Contact information
Practice address
405 W JACKSON ST, CARBONDALE, IL 62901-1462
(618) 549-0721
(618) 351-4968
Mailing address
PO BOX 1105, INDIANAPOLIS, IN 46206-1105
(618) 457-5200
Taxonomy
Speciality
Code
Description
License number
State
207ZC0500X
Cytopathology Physician
01073858A
IN
207ZC0500X
Cytopathology Physician
Primary
036140523
IL
207ZP0101X
Anatomic Pathology Physician
ME 123583
FL
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
036140523
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
214881
MEDICARE GROUP
IL
Enumeration date
05/04/2010
Last updated
09/27/2021
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