Healthcare Provider Details

I. General information

NPI: 1689616815
Provider Name (Legal Business Name): JOHN G FLEISCHLI DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 01/26/2024
Certification Date: 01/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 OLD JACKSONVILLE RD STE C
SPRINGFIELD IL
62704-7437
US

IV. Provider business mailing address

1745 W WALNUT ST
JACKSONVILLE IL
62650-6126
US

V. Phone/Fax

Practice location:
  • Phone: 217-546-5949
  • Fax:
Mailing address:
  • Phone: 800-532-6279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number016004737
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: