Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Kenneth James Minielly, MD

Individual provider Dermatology Physician · NPI 1699125062

Kenneth James Minielly, MD is a Dermatology in Springfield, Illinois. Graduated from Southern Illinois University School of Medicine in 2020, 6 years ago. Practices with Kentucky Skin Cancer Center PLLC, a 12-clinician group and accepts Medicare assignment. Licensed in Illinois.

Years since qualifying
6
Trained at
Southern Illinois University School of Medicine
Licensed in
IL
In the registry since
2016
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

751 N Rutledge St Ste 2300
Springfield, IL 62702-4968
Phone: (217) 545-8000
Fax: (217) 545-7438
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Dermatology Physician (primary) Taxonomy 207N00000X · Licence 125-068691 (IL)

Record details

NPI number1699125062
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedJune 16, 2016
Last updated in NPPESJune 16, 2016

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyDERMATOLOGY
Medical schoolSOUTHERN ILLINOIS UNIVERSITY SCHOOL OF MEDICINE
Graduated 2020 (6 years in practice)
Group practice Kentucky Skin Cancer Center Pllc — 12 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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