Healthcare Provider Details

I. General information

NPI: 1407912264
Provider Name (Legal Business Name): ENDOCRINE ASSOCIATES OF THE QUAD CITIES S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 06/15/2022
Certification Date: 06/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 35TH AVE
MOLINE IL
61265-6176
US

IV. Provider business mailing address

612 35TH AVE
MOLINE IL
61265-6176
US

V. Phone/Fax

Practice location:
  • Phone: 309-788-0014
  • Fax: 309-623-4638
Mailing address:
  • Phone: 309-788-0014
  • Fax: 309-623-4638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number1238136
License Number StateIA

VIII. Authorized Official

Name: JULIE ELAINE OESTREICH
Title or Position: OFFICE MANAGER
Credential:
Phone: 309-788-0014