Healthcare Provider Details

I. General information

NPI: 1346534724
Provider Name (Legal Business Name): ADAM EMIL COLEN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2011
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 N ALLEN ROAD MIDWEST ORTHOPAEDIC CENTER SC
PEORIA IL
61614
US

IV. Provider business mailing address

6000 N ALLEN ROAD MIDWEST ORTHOPAEDIC CENTER SC
PEORIA IL
61614
US

V. Phone/Fax

Practice location:
  • Phone: 309-691-1400
  • Fax: 309-689-7094
Mailing address:
  • Phone: 309-691-1400
  • Fax: 309-689-7094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036138270
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number036138270
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number036138270
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: