Healthcare Provider Details

I. General information

NPI: 1508926684
Provider Name (Legal Business Name): DAVID J FLETCHER MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1806 N MARKET ST
CHAMPAIGN IL
61822
US

IV. Provider business mailing address

1806 N MARKET ST
CHAMPAIGN IL
61822
US

V. Phone/Fax

Practice location:
  • Phone: 217-356-6150
  • Fax: 217-356-7167
Mailing address:
  • Phone: 217-356-6150
  • Fax: 217-356-7167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: MR. DAVID J FLETCHER
Title or Position: OWNER MEDICAL DIRECTOR
Credential: MD MPH FACOEM
Phone: 217-356-6150