MEDICARE: SENIOR HEALTH AND GERIATRICS OF CENTRAL ILLINOIS

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	207RG0300X	Geriatric Medicine (Internal Medicine) Physician

General Provider Information

NPI Number	:	1477676757
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SENIOR HEALTH AND GERIATRICS OF CENTRAL ILLINOIS

Provider Business Mailing Address
First Line	:	2103 E. WASHINGTON ST
Second Line	:	2C
City	:	B LOOMINGTON
State	:	IL
Zip	:	61701-4365
Country	:	US
Telephone Number	:	309-663-5810
Fax Number	:

Provider Business Practice Location Address
First Line	:	2103 E. WASHINGTON ST
Second Line	:	2C
City	:	B LOOMINGTON
State	:	IL
Zip	:	61701-4365
Country	:	US
Telephone Number	:	309-663-5810
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. UDAY L DEOSKAR
Credential	:	M.D.
Telephone Number	:	309-663-5810

Provider Enumeration Date	:	04/09/2007
Last Update Date	:	03/14/2008

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