Healthcare Provider Details

I. General information

NPI: 1982052585
Provider Name (Legal Business Name): SPRINGBOARD PEDIATRICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2016
Last Update Date: 12/24/2025
Certification Date: 12/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2980 N MAIN ST SUITE 2
DECATUR IL
62526-3291
US

IV. Provider business mailing address

2980 N MAIN ST SUITE 2
DECATUR IL
62526-3291
US

V. Phone/Fax

Practice location:
  • Phone: 217-706-0953
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARTIN OKPALIKE
Title or Position: PRESIDENT
Credential: MD
Phone: 217-876-8000