Healthcare Provider Details

I. General information

NPI: 1336237296
Provider Name (Legal Business Name): CARLOS G FIOR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 06/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2981 N MAIN ST
DECATUR IL
62526-3259
US

IV. Provider business mailing address

2981 N MAIN ST
DECATUR IL
62526-3259
US

V. Phone/Fax

Practice location:
  • Phone: 217-542-1293
  • Fax: 217-877-9806
Mailing address:
  • Phone: 217-542-1293
  • Fax: 217-877-9806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036071478
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: