Healthcare Provider Details

I. General information

NPI: 1568656999
Provider Name (Legal Business Name): ROBERT G GERMAN MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2007
Last Update Date: 09/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 ROOSEVELT ST
CLINTON IA
52732-2412
US

IV. Provider business mailing address

4909 N GLEN PARK PLACE RD
PEORIA IL
61614-4676
US

V. Phone/Fax

Practice location:
  • Phone: 563-242-3571
  • Fax: 563-243-4971
Mailing address:
  • Phone: 309-674-7546
  • Fax: 309-282-0500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CARL W SODERSTROM
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 309-674-7546