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General NPI Number Information
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NPI Number | 1376596395
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Entity Type | Individual
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Provider Name | GREGG T PODLESKI D.O.
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Gender | Male
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Dates
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Enumeration Date | 05/19/2006
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 1215 FRANCISCAN DR
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City | LITCHFIELD
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State | IL
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Zip | 62056-1799
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Country | US
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Telephone | 217-324-2191
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Fax |
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Provider Business Mailing Address
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Address Line | 1301 S KOKE MILL RD
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City | SPRINGFIELD
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State | IL
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Zip | 62711-9252
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Country | US
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Telephone | 217-547-9100
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Fax | 217-547-9236
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 036.175883
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License Number State | IL
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