Healthcare Provider Details

I. General information

NPI: 1306048723
Provider Name (Legal Business Name): OBSTETRICS & GYNECOLOGY II, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1302 FRANKLIN AVE SUITE 2800
NORMAL IL
61761-3551
US

IV. Provider business mailing address

1302 FRANKLIN AVE SUITE 2800
NORMAL IL
61761-3551
US

V. Phone/Fax

Practice location:
  • Phone: 309-454-1074
  • Fax:
Mailing address:
  • Phone: 309-454-1074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036059120
License Number StateIL

VIII. Authorized Official

Name: MRS. JODI RENEE HOBBS
Title or Position: BILLING
Credential:
Phone: 309-454-1074