Facts
- Status
- A
- Credential
- DC
- Type
- Individual
- Enumeration date
- 2006-04-03
- Last updated
- 2026-06-01
Specialties
Licenses
- License IL
- 038009332
Location
- Practice location
- 119 RODEWALD DR
- City
- RUSHVILLE IL
- Postal code
- 626819783
- Phone
- 217-322-2370
Medicare
- PECOS
- A PECOS enrollment row matches this NPI.
LEIE
The OIG NPI list is not in this build yet. Confirm on OIG's search.
Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.