Healthcare Provider Details

I. General information

NPI: 1720103153
Provider Name (Legal Business Name): WILLIAM CIFUENTES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1109 S LINCOLN AVE
URBANA IL
61801-4703
US

IV. Provider business mailing address

244 COUNTY ROAD 2600 N
MAHOMET IL
61853-9724
US

V. Phone/Fax

Practice location:
  • Phone: 217-333-3264
  • Fax:
Mailing address:
  • Phone: 217-586-6550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: