| Edward W Pegg Md, Llc | |
|
1505 Eastland Dr Ste 2400 Bloomington IL 61701-7911 | |
| (309) 661-7344 | |
| (309) 661-7343 |
| Full Name | Edward W Pegg Md, Llc |
|---|---|
| Speciality | Psychiatry & Neurology - Neurology |
| Location | 1505 Eastland Dr Ste 2400, Bloomington, Illinois |
| Authorized Official Name and Position | Edward W Pegg (OWNER) |
| Authorized Official Contact | 3096617344 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Edward W Pegg Md, Llc 1505 Eastland Dr Ste 2400 Bloomington IL 61701-7911 Ph: (309) 661-7344 | Edward W Pegg Md, Llc 1505 Eastland Dr Ste 2400 Bloomington IL 61701-7911 Ph: (309) 661-7344 |
| NPI Number | 1568667772 |
|---|---|
| Provider Enumeration Date | 06/18/2007 |
| Last Update Date | 05/29/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568667772 | NPI | - | NPPES |
| 05732102 | Other | IL | BCBS |
| 1043392160 | Other | IL | INDIVIDUAL NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | 036071077 (Illinois) | Primary |
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