Healthcare Provider Details

I. General information

NPI: 1629152574
Provider Name (Legal Business Name): FIVE APPLES INPATIENT SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 08/17/2021
Certification Date: 08/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 BROWN BLVD STE 103
BOURBONNAIS IL
60914
US

IV. Provider business mailing address

475 BROWN BLVD STE 103
BOURBONNAIS IL
60914
US

V. Phone/Fax

Practice location:
  • Phone: 815-937-7962
  • Fax: 815-936-8650
Mailing address:
  • Phone: 815-937-7962
  • Fax: 815-936-8650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036104924
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. TERRILL APPLEWHITE
Title or Position: OWNER
Credential: M.D.
Phone: 815-937-7962