Healthcare Provider Details

I. General information

NPI: 1164616389
Provider Name (Legal Business Name): CONTEMPORARY OBSTETRICS & GYNECOLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2007
Last Update Date: 03/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2304 STERN DR
BLOOMINGTON IL
61704-4487
US

IV. Provider business mailing address

2304 STERN DR
BLOOMINGTON IL
61704-4487
US

V. Phone/Fax

Practice location:
  • Phone: 309-663-0411
  • Fax: 309-662-2018
Mailing address:
  • Phone: 309-663-0411
  • Fax: 309-662-2018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: HEATHER L DUDLEY
Title or Position: PRESIDENT
Credential: D.O.
Phone: 309-663-0411