Healthcare Provider Details

I. General information

NPI: 1730261363
Provider Name (Legal Business Name): ACPM PODIATRY GROUP, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5017 N GLEN PARK PLACE RD
PEORIA IL
61614-4677
US

IV. Provider business mailing address

5017 N GLEN PARK PLACE RD
PEORIA IL
61614-4677
US

V. Phone/Fax

Practice location:
  • Phone: 309-691-1589
  • Fax: 309-692-2032
Mailing address:
  • Phone: 309-691-1589
  • Fax: 309-692-2032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number060001998
License Number StateIL

VIII. Authorized Official

Name: DR. ANTHONY V DECEANNE
Title or Position: OWNER
Credential: DPM
Phone: 309-691-1589