Healthcare Provider Details

I. General information

NPI: 1790620995
Provider Name (Legal Business Name): CARE CONNECT OF ILLINOIS PROVIDERS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

519 ELLIOTT ST STE S1
KEWANEE IL
61443-2776
US

IV. Provider business mailing address

456 FULTON ST STE 360
PEORIA IL
61602-1289
US

V. Phone/Fax

Practice location:
  • Phone: 309-525-0703
  • Fax:
Mailing address:
  • Phone: 309-525-0703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL AHEARN
Title or Position: OWNER
Credential: MD
Phone: 309-525-0703