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General NPI Number Information
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NPI Number | 1942476668
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Entity Type | Organization
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Legal Business Name | DANVILLE PEDIATRIC CENTER
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Dates
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Enumeration Date | 05/02/2008
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Last Update Date | 06/23/2008
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Provider Practice Location Address
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Address Line | 723 N LOGAN AVE
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City | DANVILLE
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State | IL
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Zip | 61832-4384
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Country | US
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Telephone | 217-446-3259
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Fax |
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Provider Business Mailing Address
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Address Line | 723 N LOGAN AVE
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City | DANVILLE
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State | IL
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Zip | 61832-4384
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Country | US
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Telephone | 217-446-3259
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Fax |
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Authorized Official
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Title or Position | M.D.
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Name | DR. ROBERT ELGHAMMER
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Credential |
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Telephone | 217-446-3259
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 036-028934
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License Number State | IL
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