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General NPI Number Information
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NPI Number | 1922823913
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Entity Type | Organization
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Legal Business Name | ACCILIEN ENTERPRISES IL PLLC
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Dates
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Enumeration Date | 11/15/2024
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Last Update Date | 02/10/2025
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Provider Practice Location Address
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Address Line | 2203 EASTLAND DR STE 7
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City | BLOOMINGTON
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State | IL
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Zip | 61704-7924
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Country | US
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Telephone | 309-808-1700
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Fax |
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Provider Business Mailing Address
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Address Line | 2203 EASTLAND DR STE 7
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City | BLOOMINGTON
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State | IL
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Zip | 61704-7924
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Country | US
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Telephone | 309-808-1700
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | YVES-DANY ACCILIEN
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Credential | MD
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Telephone | 813-924-0236
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number |
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License Number State |
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