Healthcare Provider Details

I. General information

NPI: 1275539918
Provider Name (Legal Business Name): DAVID K ISRAEL D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 COMMERCE ST
CARMI IL
62821-2223
US

IV. Provider business mailing address

PO BOX 155
CHRISTOPHER IL
62822-0155
US

V. Phone/Fax

Practice location:
  • Phone: 618-384-5686
  • Fax: 618-382-2882
Mailing address:
  • Phone: 618-724-2401
  • Fax: 618-724-4628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036104743
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: