Healthcare Provider Details

I. General information

NPI: 1225144553
Provider Name (Legal Business Name): ADAM EBREO D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 11/29/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1302 FRANKLIN AVE SUITE 1100
NORMAL IL
61761-3551
US

IV. Provider business mailing address

1302 FRANKLIN AVE SUITE 1100
NORMAL IL
61761-3551
US

V. Phone/Fax

Practice location:
  • Phone: 309-268-2727
  • Fax:
Mailing address:
  • Phone: 309-268-2727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036-108446
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: