IndividualActive
Kevin Izquierdo
NPI 1205449626 · Sports Medicine (Family Medicine) Physician · Carbondale, IL
Provider details
- NPI number
- 1205449626
- Entity type
- Individual
- Primary specialty
- Sports Medicine (Family Medicine) PhysicianAllopathic & Osteopathic Physicians
- Sex
- Male
- Sole proprietor
- No
- License
- 125.086053 (IL)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Practice location
300 W Oak St Ste 200
Carbondale, IL 62901-1400
Phone: (618) 536-6621
Approximate (ZIP-level) locationGet directions
Mailing address
300 W Oak St Ste 200
Carbondale, IL 62901-1400
Registry dates
- Enumerated
- 2020-08-25
- Last updated
- 2025-12-22
- Certified
- 2025-12-22
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.