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NPI Code Detail

MEDICARE: DR. GLEN N FEATHER DO

MEDICARE: DR. GLEN N FEATHER DO
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
1207L00000XAnesthesiology Physician036079920IL
2207LP2900XPain Medicine (Anesthesiology) Physician036079920IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1962492900
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GLEN N FEATHER DO
Provider Business Mailing Address
First Line : 2907 W WARDCLIFFE DR
Second Line :
City : PEORIA
State : IL
Zip : 61604-2157
Country : US
Telephone Number : 309-404-1914
Fax Number :
Provider Business Practice Location Address
First Line : 180 S MAIN ST
Second Line :
City : CANTON
State : IL
Zip : 61520-2608
Country : US
Telephone Number : 309-647-0201
Fax Number : 309-649-6880
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/21/2005
Last Update Date : 11/18/2019

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Directions to “ DR. GLEN N FEATHER DO” Practice Location

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