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General NPI Number Information
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NPI Number | 1174320873
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Entity Type | Organization
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Legal Business Name | CEP AMERICA ILLINOIS INTENSIVISTS
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Dates
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Enumeration Date | 02/28/2025
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Last Update Date | 02/28/2025
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Provider Practice Location Address
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Address Line | 500 W COURT ST
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City | KANKAKEE
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State | IL
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Zip | 60901-3661
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Country | US
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Telephone | 815-937-2400
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Fax |
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Provider Business Mailing Address
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Address Line | 2100 POWELL ST STE 400
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City | EMERYVILLE
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State | CA
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Zip | 94608-1872
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Country | US
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Telephone | 510-851-7501
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATIVE VP OF OPERATIONS
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Name | DAVID BIRDSALL
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Credential | MD
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Telephone | 510-350-2600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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