Basic Information
| Provider Information | |||||||||
| NPI: | 1508012527 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOPKINS | ||||||||
| FirstName: | KELSEY | ||||||||
| MiddleName: | MICHAEL | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1207 NETWORK CENTRE DR STE 3 | ||||||||
| Address2: | |||||||||
| City: | EFFINGHAM | ||||||||
| State: | IL | ||||||||
| PostalCode: | 624014632 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2173472707 | ||||||||
| FaxNumber: | 2173472827 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 RED BALL TRL | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622462781 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6186641240 | ||||||||
| FaxNumber: | 6186902189 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2008 | ||||||||
| LastUpdateDate: | 10/29/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 036126037 | IL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.