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General NPI Number Information
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NPI Number | 1386601391
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Entity Type | Individual
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Provider Name | CARL PETER BIRK JR. M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/26/2006
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Last Update Date | 10/10/2008
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Provider Practice Location Address
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Address Line | 302 W HAY ST STE 140
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City | DECATUR
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State | IL
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Zip | 62526-4167
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Country | US
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Telephone | 217-876-2730
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Fax | 217-876-2735
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Provider Business Mailing Address
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Address Line | 2300 N EDWARD ST GSBLL
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City | DECATUR
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State | IL
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Zip | 62526-4163
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Country | US
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Telephone | 217-876-2730
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Fax | 217-876-2735
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 036042482
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License Number State | IL
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