Healthcare Provider Details

I. General information

NPI: 1952521791
Provider Name (Legal Business Name): PHILIP I WOERNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 05/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 SE CROSS MENTAL HEALTH CENTERS OF WESTERN ILLINOIS
MT STERLING IL
62353
US

IV. Provider business mailing address

238 HEATHERSTONE DR
CHATHAM IL
62629-8697
US

V. Phone/Fax

Practice location:
  • Phone: 217-773-3325
  • Fax: 217-773-2425
Mailing address:
  • Phone: 217-546-3717
  • Fax: 217-773-2425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number036041485
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: