Healthcare Provider Details

I. General information

NPI: 1174732945
Provider Name (Legal Business Name): DOUGLAS M. KUHL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 12/22/2021
Certification Date: 12/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9401 HOLY CROSS LN SUITE 112B
BREESE IL
62230-3510
US

IV. Provider business mailing address

9401 HOLY CROSS LN SUITE 112B
BREESE IL
62230-3510
US

V. Phone/Fax

Practice location:
  • Phone: 618-526-7271
  • Fax: 618-526-7313
Mailing address:
  • Phone: 618-526-7271
  • Fax: 618-526-7313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036129742
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: