Healthcare Provider Details

I. General information

NPI: 1508546987
Provider Name (Legal Business Name): KELINE PETERS HOOD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2023
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 ROBINSON ST
DANVILLE IL
61832-8515
US

IV. Provider business mailing address

101 W UNIVERSITY AVE
CHAMPAIGN IL
61820-3981
US

V. Phone/Fax

Practice location:
  • Phone: 217-442-8611
  • Fax:
Mailing address:
  • Phone: 217-443-0146
  • Fax: 217-442-8649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036.180314
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: