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NPI Code Detail

MEDICARE: PEORIA PULMONARY ASSOCIATES, LTD.

MEDICARE: PEORIA PULMONARY ASSOCIATES, LTD.
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
1207RC0200XCritical Care Medicine (Internal Medicine) Physician
2207RP1001XPulmonary Disease Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
17215056OTHERILBCBS GROUP NUMBER

General Provider Information

NPI Number : 1831143585
Entity Type Code : Organization
Provider Name (Legal Business Name) : PEORIA PULMONARY ASSOCIATES, LTD.
Provider Business Mailing Address
First Line : 1001 MAIN ST
Second Line : SUITE 200
City : PEORIA
State : IL
Zip : 61606-1907
Country : US
Telephone Number : 309-672-5682
Fax Number : 309-672-3147
Provider Business Practice Location Address
First Line : 1001 MAIN ST
Second Line : SUITE 200
City : PEORIA
State : IL
Zip : 61606-1907
Country : US
Telephone Number : 309-672-5682
Fax Number : 309-672-3147
Authorized Official
Title or Position : EMR MANAGER
Name : JANET L JACKSON
Credential :
Telephone Number : 309-672-5682
Provider Enumeration Date : 05/19/2006
Last Update Date : 01/21/2009

Similar Medicare Providers

1932195880 — SUBRAMANYAM CHITTIVELU M.D.
Practice Location Address:
1001 MAIN ST , SUITE 200
PEORIA, IL
61606-1907
Practice Phone: 309-672-5682
Practice Fax: 309-672-3147
1073509824 — JEREMIAH EDWARD CRABB VI M.D.
Practice Location Address:
1001 MAIN ST , SUITE 200
PEORIA, IL
61606-1907
Practice Phone: 309-672-5682
Practice Fax: 309-672-3147
1821084567 — MICHAEL LEROY PEIL M.D.
Practice Location Address:
1001 MAIN ST , SUITE 200
PEORIA, IL
61606-1907
Practice Phone: 309-672-5682
Practice Fax: 309-672-3147
1366438087 — PATRICK E WHITTEN M.D.
Practice Location Address:
1001 MAIN ST , SUITE 200
PEORIA, IL
61606-1907
Practice Phone: 309-672-5682
Practice Fax: 309-672-3147
1649260076 — DR. W ANTHONY SAUDER M.D.
Practice Location Address:
1001 MAIN ST , SUITE 200
PEORIA, IL
61606-1907
Practice Phone: 309-672-5682
Practice Fax: 309-672-3147
1316991193 — OSSAMA IKLADIOS MD
Practice Location Address:
1001 MAIN ST , SUITE 200
PEORIA, IL
61606-1907
Practice Phone: 309-672-5682
Practice Fax: 309-672-3147

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