Healthcare Provider Details

I. General information

NPI: 1851316129
Provider Name (Legal Business Name): RALPH KEHL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 05/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 W. PARK ST.
URBANA IL
61801-2500
US

IV. Provider business mailing address

611 W. PARK ST. BWPC
URBANA IL
61801-2502
US

V. Phone/Fax

Practice location:
  • Phone: 217-383-4930
  • Fax: 217-383-4014
Mailing address:
  • Phone: 217-383-6792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number036072435
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: