Healthcare Provider Details

I. General information

NPI: 1255560629
Provider Name (Legal Business Name): EMILY A ARTIME PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2009
Last Update Date: 12/20/2021
Certification Date: 12/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1770 E LAKE SHORE DR STE 105
DECATUR IL
62521-3800
US

IV. Provider business mailing address

1770 E LAKE SHORE DR STE 105
DECATUR IL
62521-3800
US

V. Phone/Fax

Practice location:
  • Phone: 217-329-1000
  • Fax: 217-329-1055
Mailing address:
  • Phone: 217-329-1000
  • Fax: 217-329-1055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085003477
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: