Healthcare Provider Details

I. General information

NPI: 1346817566
Provider Name (Legal Business Name): RACHAEL A PLANTHOLT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2021
Last Update Date: 12/19/2024
Certification Date: 12/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1437 E COLLEGE AVE
NORMAL IL
61761-2085
US

IV. Provider business mailing address

611 W PARK FAPC
URBANA IL
61802
US

V. Phone/Fax

Practice location:
  • Phone: 309-862-5700
  • Fax: 309-862-5705
Mailing address:
  • Phone: 217-902-6954
  • Fax: 217-902-7711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4351048691
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: