Kellerman, Kevin John

Kellerman, Kevin John is an individual health care provider with primary practice located at 16 Junction Dr W Suite 101, Glen Carbon IL 62034-2996. He recently has only one registered license in Dental Providers / General Practice, which is considered as his primary health care specialty. Kellerman, Kevin John can be contacted via phone (618) 228-3100.

Contact Information

Primary practice address
16 Junction Dr W Suite 101 Glen Carbon IL 62034-2996
Phone: (618) 228-3100
Fax: (618) 288-3434
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / General Practice 1223G0001X 019-025862 Illinois

Profile Details

NPI number 1962419317
LBN Legal business name Kellerman, Kevin John
Credentials Doctor of Dental Medicine (DMD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 1st, 2006
Last updated May 13th, 2021 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1962419317 NPPES
Illinois MEDICAID 108441

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