Provider Demographics
NPI:1841226222
Name:NEWELL, KIP CARDELL (DO)
Entity Type:Individual
Prefix:MR
First Name:KIP
Middle Name:CARDELL
Last Name:NEWELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:2551 W KEARNEY ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65803-2034
Mailing Address - Country:US
Mailing Address - Phone:417-210-6025
Mailing Address - Fax:417-869-4280
Practice Address - Street 1:2551 W KEARNEY ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65803-2034
Practice Address - Country:US
Practice Address - Phone:417-210-6025
Practice Address - Fax:417-869-4280
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363124673207L00000X
IL336.086016207L00000X
IL136.124673207L00000X
MO2010003248207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology