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General NPI Number Information
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NPI Number | 1942592118
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Entity Type | Organization
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Legal Business Name | HEART OF ILLINOIS OBSTETRICS AND GYNECOLOGY, S.C.
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Dates
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Enumeration Date | 05/06/2011
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Last Update Date | 12/15/2025
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Provider Practice Location Address
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Address Line | 1505 EASTLAND DR STE 2200
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City | BLOOMINGTON
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State | IL
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Zip | 61701-7910
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Country | US
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Telephone | 309-454-3456
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Fax | 309-454-6977
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Provider Business Mailing Address
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Address Line | 1505 EASTLAND DR STE 2200
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City | BLOOMINGTON
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State | IL
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Zip | 61701-7910
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Country | US
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Telephone | 309-454-3456
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Fax | 309-454-6977
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MELISSA G GEORGAS
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Credential |
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Telephone | 309-838-6748
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 036068939
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License Number State | IL
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