Healthcare Provider Details

I. General information

NPI: 1144270596
Provider Name (Legal Business Name): JEROME J EPPLIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 04/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1285 FRANCISCAN DR
LITCHFIELD IL
62056-1778
US

IV. Provider business mailing address

1285 FRANCISCAN DR
LITCHFIELD IL
62056-1778
US

V. Phone/Fax

Practice location:
  • Phone: 217-324-6127
  • Fax: 217-324-5959
Mailing address:
  • Phone: 217-324-6127
  • Fax: 217-324-5959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036053272
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number036053272
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: