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General NPI Number Information
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NPI Number | 1437697307
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Entity Type | Organization
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Legal Business Name | BAYVIEW FAMILY CLINIC LTD
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Dates
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Enumeration Date | 02/10/2017
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Last Update Date | 04/29/2022
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Provider Practice Location Address
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Address Line | 405 SHERIDAN ST
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City | DANVILLE
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State | IL
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Zip | 61832-4451
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Country | US
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Telephone | 217-446-3259
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Fax | 217-446-4132
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Provider Business Mailing Address
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Address Line | 405 SHERIDAN ST
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City | DANVILLE
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State | IL
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Zip | 61832-4451
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | LINUS UCHECHUKWU ANUKWU
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Credential | MD
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Telephone | 217-530-2106
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | 209015479
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License Number State | IL
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