MEDICARE: CAMERON PHALEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program		IL

General Provider Information

NPI Number	:	1447194139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAMERON PHALEN

Provider Business Mailing Address
First Line	:	1802 JUNIPER DR
Second Line	:
City	:	PERU
State	:	IL
Zip	:	61354-1642
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	215 RICHARD A MAUTINO DR
Second Line	:
City	:	SPRING VALLEY
State	:	IL
Zip	:	61362-1144
Country	:	US
Telephone Number	:	815-664-5331
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/15/2026
Last Update Date	:	04/15/2026

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Directions to “ CAMERON PHALEN ” Practice Location

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