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NPI Code Detail

MEDICARE: DR. JAMES FRANCIS QUEENAN III D.O.

MEDICARE: DR. JAMES FRANCIS QUEENAN III D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207X00000XOrthopaedic Surgery Physician2007018575MO
2207X00000XOrthopaedic Surgery Physician036142261IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1376535435
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JAMES FRANCIS QUEENAN III D.O.
Provider Business Mailing Address
First Line : 180 S MAIN ST
Second Line :
City : CANTON
State : IL
Zip : 61520-2608
Country : US
Telephone Number : 309-647-0201
Fax Number : 309-647-8613
Provider Business Practice Location Address
First Line : 180 S MAIN ST
Second Line :
City : CANTON
State : IL
Zip : 61520-2608
Country : US
Telephone Number : 309-647-0201
Fax Number : 309-649-6880
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/16/2005
Last Update Date : 04/13/2021

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