Healthcare Provider Details

I. General information

NPI: 1497942791
Provider Name (Legal Business Name): L.E. MCNEILL, MD SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2007
Last Update Date: 12/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 W LINCOLN AVE SUITES 200A&B
CHARLESTON IL
61920-2453
US

IV. Provider business mailing address

506 W LINCOLN AVE SUITES 200A&B
CHARLESTON IL
61920-2453
US

V. Phone/Fax

Practice location:
  • Phone: 217-348-8727
  • Fax: 217-345-7146
Mailing address:
  • Phone: 217-348-8727
  • Fax: 217-345-7146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LELAND E MCNEILL
Title or Position: MEDICAL DOCTOR
Credential: MDSC
Phone: 217-348-8727