KENNETH JAMES MINIELLY MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125068691

License Status

EXPIRED

Business

Title

First Name

KENNETH

Middle

JAMES

Last Name

MINIELLY

Business Name

KENNETH JAMES MINIELLY MD

Original Issue Date

06/26/2019

Effective Date

06/26/2019

Expiration Date

06/25/2020

City

SPRINGFIELD

State

Zip

62701

County

SANGAMON

Specialty/Qualifier

Dermatology

Ever Disciplined

LastModifiedDate

11/19/2020