Healthcare Provider Details

I. General information

NPI: 1891779203
Provider Name (Legal Business Name): LE MCNEILL MD SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 W LINCOLN STE 200 A & B
CHARLESTON IL
61920
US

IV. Provider business mailing address

506 W LINCOLN STE 200 A & B
CHARLESTON IL
61920
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 StateIL

VIII. Authorized Official

Name: LELAND E MCNEILL
Title or Position: DOCTOR
Credential: MD
Phone: 217-348-8727