Facts
- Status
- A
- Type
- Individual
- Enumeration date
- 2026-09-01
- Last updated
- 2026-09-01
Specialties
Licenses
- License IL
- 150.129028
Location
- Practice location
- 939 GALENA SQUARE DR STE B
- City
- GALENA IL
- Postal code
- 610361355
- Phone
- 815-391-1000
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
The OIG NPI list is not in this build yet. Confirm on OIG's search.
Nearby
Search this city from the state hub for other records in the public registry.
Removal request
Public data from NPPES and CMS. Not a credentialing determination.