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General NPI Number Information
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NPI Number | 1477676757
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Entity Type | Organization
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Legal Business Name | SENIOR HEALTH AND GERIATRICS OF CENTRAL ILLINOIS
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Dates
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Enumeration Date | 04/09/2007
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Last Update Date | 03/14/2008
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Provider Practice Location Address
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Address Line | 2103 E. WASHINGTON ST 2C
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City | B LOOMINGTON
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State | IL
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Zip | 61701-4365
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Country | US
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Telephone | 309-663-5810
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Fax |
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Provider Business Mailing Address
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Address Line | 2103 E. WASHINGTON ST 2C
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City | B LOOMINGTON
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State | IL
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Zip | 61701-4365
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Country | US
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Telephone | 309-663-5810
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. UDAY L DEOSKAR
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Credential | M.D.
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Telephone | 309-663-5810
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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