Healthcare Provider Details

I. General information

NPI: 1497753974
Provider Name (Legal Business Name): MICHAEL VAIL COMERFORD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 W MOUND RD
DECATUR IL
62526-1964
US

IV. Provider business mailing address

176 W MOUND RD
DECATUR IL
62526-1964
US

V. Phone/Fax

Practice location:
  • Phone: 217-875-0163
  • Fax: 217-875-9007
Mailing address:
  • Phone: 217-875-0163
  • Fax: 217-875-9007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036094991
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036094991
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: