Healthcare Provider Details

I. General information

NPI: 1346528486
Provider Name (Legal Business Name): ROBERT D QUEVILLON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2011
Last Update Date: 07/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 E CASS ST
JOLIET IL
60432-2812
US

IV. Provider business mailing address

204 ILLINI DR
MINOOKA IL
60447
US

V. Phone/Fax

Practice location:
  • Phone: 815-726-3377
  • Fax:
Mailing address:
  • Phone: 815-521-0601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036.106715
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: