Healthcare Provider Details

I. General information

NPI: 1356732101
Provider Name (Legal Business Name): BRIAN A SCHROCK PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2015
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 S SWEETBRIAR DR
CHILLICOTHEE IL
61523-2264
US

IV. Provider business mailing address

525 S SWEETBRIAR DR
CHILLICOTHEE IL
61523-2264
US

V. Phone/Fax

Practice location:
  • Phone: 309-274-2102
  • Fax:
Mailing address:
  • Phone: 309-274-2102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085-005406
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: