Healthcare Provider Details

I. General information

NPI: 1164447058
Provider Name (Legal Business Name): ILLIANA EMERGENCY PHYSICIANS, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 01/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 N LOGAN AVE
DANVILLE IL
61832-3752
US

IV. Provider business mailing address

75 REMIT DR # 1367
CHICAGO IL
60675-1367
US

V. Phone/Fax

Practice location:
  • Phone: 217-443-5000
  • Fax: 217-443-1965
Mailing address:
  • Phone: 866-916-5259
  • Fax: 231-922-4030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMES M JOHNSON
Title or Position: LLP MANAGING PARTNER
Credential: M.D.
Phone: 800-253-5358