Healthcare Provider Details

I. General information

NPI: 1306874102
Provider Name (Legal Business Name): DIGESTIVE DISEASE CONSULTANTS LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 09/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1302 FRANKLIN AVE #4800
NORMAL IL
61761
US

IV. Provider business mailing address

1302 FRANKLIN AVE #4800
NORMAL IL
61761
US

V. Phone/Fax

Practice location:
  • Phone: 309-454-5900
  • Fax: 309-454-2820
Mailing address:
  • Phone: 309-454-5900
  • Fax: 309-454-2820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. JILL METZ
Title or Position: OFFICE MANAGER
Credential:
Phone: 309-454-5900