Healthcare Provider Details

I. General information

NPI: 1801805122
Provider Name (Legal Business Name): GUY AUDET M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 07/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 W WALNUT ST
JACKSONVILLE IL
62650-1136
US

IV. Provider business mailing address

PO BOX 1977
SPRINGFIELD IL
62705-1977
US

V. Phone/Fax

Practice location:
  • Phone: 217-243-5584
  • Fax: 217-243-5877
Mailing address:
  • Phone: 217-544-6464
  • Fax: 217-757-6021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: