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General NPI Number Information
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NPI Number | 1407912264
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Entity Type | Organization
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Legal Business Name | ENDOCRINE ASSOCIATES OF THE QUAD CITIES S.C.
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Dates
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Enumeration Date | 12/28/2006
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Last Update Date | 06/15/2022
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Provider Practice Location Address
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Address Line | 612 35TH AVE
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City | MOLINE
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State | IL
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Zip | 61265-6176
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Country | US
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Telephone | 309-788-0014
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Fax | 309-623-4638
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Provider Business Mailing Address
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Address Line | 612 35TH AVE
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City | MOLINE
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State | IL
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Zip | 61265-6176
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Country | US
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Telephone | 309-788-0014
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Fax | 309-623-4638
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | JULIE ELAINE OESTREICH
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Credential |
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Telephone | 309-788-0014
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 1238136
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License Number State | IA
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