Provider Demographics
NPI:1467430025
Name:KVELLAND, EVEN C (MD)
Entity Type:Individual
Prefix:
First Name:EVEN
Middle Name:C
Last Name:KVELLAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 N COLLEGE AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:GENESEO
Mailing Address - State:IL
Mailing Address - Zip Code:61254-1091
Mailing Address - Country:US
Mailing Address - Phone:309-946-5124
Mailing Address - Fax:309-721-1407
Practice Address - Street 1:600 N COLLEGE AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:GENESEO
Practice Address - State:IL
Practice Address - Zip Code:61254-1091
Practice Address - Country:US
Practice Address - Phone:309-946-5124
Practice Address - Fax:309-721-1407
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036051263207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0360512632Medicaid
IL110228695OtherRR MEDICARE
IL036051263Medicaid
IL1467430025Medicaid
IL1467430025Medicaid
ILL90121Medicare PIN