Healthcare Provider Details

I. General information

NPI: 1336104884
Provider Name (Legal Business Name): TERESA JEAN MORRELL RIECH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TERESA JEAN RIECH

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 07/09/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 NE GLEN OAK AVE
PEORIA IL
61637-5402
US

IV. Provider business mailing address

530 NE GLEN OAK AVE
PEORIA IL
61637-0001
US

V. Phone/Fax

Practice location:
  • Phone: 309-655-2553
  • Fax: 309-655-2602
Mailing address:
  • Phone: 309-655-2553
  • Fax: 309-655-2602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036118982
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01059317A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01059317A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036118982
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: