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General NPI Number Information
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NPI Number | 1740598234
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Entity Type | Organization
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Legal Business Name | GREGORY L. TOTEL, M.D.,S.C.
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Dates
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Enumeration Date | 09/17/2010
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Last Update Date | 09/17/2010
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Provider Practice Location Address
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Address Line | 1 MEMORIAL DR STE 201
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City | DECATUR
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State | IL
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Zip | 62526-6317
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Country | US
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Telephone | 217-875-1090
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Fax | 217-875-1099
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Provider Business Mailing Address
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Address Line | 1 MEMORIAL DR STE 201
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City | DECATUR
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State | IL
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Zip | 62526-6317
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Country | US
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Telephone | 217-875-1090
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Fax | 217-875-1099
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Authorized Official
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Title or Position | PRESIDENT
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Name | GREGORY LEE TOTEL
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Credential | M.D.
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Telephone | 217-875-1090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 036068474
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License Number State | IL
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