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General NPI Number Information
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NPI Number | 1346817566
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Entity Type | Individual
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Provider Name | RACHAEL A PLANTHOLT MD
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Gender | Female
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Dates
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Enumeration Date | 06/07/2021
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Last Update Date | 12/19/2024
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Provider Practice Location Address
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Address Line | 1437 E COLLEGE AVE
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City | NORMAL
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State | IL
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Zip | 61761-2085
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Country | US
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Telephone | 309-862-5700
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Fax | 309-862-5705
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Provider Business Mailing Address
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Address Line | 611 W PARK FAPC
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City | URBANA
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State | IL
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Zip | 61802
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Country | US
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Telephone | 217-902-6954
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Fax | 217-902-7711
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 4351048691
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License Number State | MI
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