Healthcare Provider Details

I. General information

NPI: 1952513483
Provider Name (Legal Business Name): REPRODUCTIVE ENDOCRINOLOGY ASSOCIATES, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 W MILLER STREET
SPRINGFIELD IL
62702
US

IV. Provider business mailing address

340 W MILLER STREET
SPRINGFIELD IL
62702
US

V. Phone/Fax

Practice location:
  • Phone: 217-523-4700
  • Fax: 217-523-9025
Mailing address:
  • Phone: 217-523-4700
  • Fax: 217-523-9025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number
License Number State

VIII. Authorized Official

Name: PHILLIP C GALLE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 217-523-4700