Healthcare Provider Details

I. General information

NPI: 1437785656
Provider Name (Legal Business Name): WILLIAM TRULOVE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2020
Last Update Date: 03/19/2020
Certification Date: 03/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 N MAIN ST
EAST PEORIA IL
61611-2543
US

IV. Provider business mailing address

129 N MAIN ST
EAST PEORIA IL
61611-2543
US

V. Phone/Fax

Practice location:
  • Phone: 309-698-3300
  • Fax:
Mailing address:
  • Phone: 309-698-3300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number3191
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: