Healthcare Provider Details

I. General information

NPI: 1710618566
Provider Name (Legal Business Name): JOSHUA VALDEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2022
Last Update Date: 07/06/2023
Certification Date: 07/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 W KENWOOD AVE STE 100
DECATUR IL
62526-4379
US

IV. Provider business mailing address

3976 N WATER ST
DECATUR IL
62526-1855
US

V. Phone/Fax

Practice location:
  • Phone: 217-872-3811
  • Fax: 217-872-0849
Mailing address:
  • Phone: 630-696-1018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number125.080959
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125.080959
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: