Healthcare Provider Details

I. General information

NPI: 1710083563
Provider Name (Legal Business Name): BRUCE E SEMANS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E MAIN ST
ROCHESTER IL
62563-9507
US

IV. Provider business mailing address

101 E MAIN ST
ROCHESTER IL
62563-9507
US

V. Phone/Fax

Practice location:
  • Phone: 217-498-5949
  • Fax: 217-498-5950
Mailing address:
  • Phone: 217-498-5949
  • Fax: 217-498-5950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number036-099321
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: