| Endocrine & Diabetes, Sc | |
|
3308 W Chartwell Rd Peoria IL 61614-2322 | |
| (309) 691-7640 | |
| (309) 691-7640 |
| Full Name | Endocrine & Diabetes, Sc |
|---|---|
| Speciality | Internal Medicine |
| Location | 3308 W Chartwell Rd, Peoria, Illinois |
| Authorized Official Name and Position | Thomas R Dorsch (PRESIDENT) |
| Authorized Official Contact | 3096917640 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Endocrine & Diabetes, Sc 3308 W Chartwell Rd Peoria IL 61614-2322 Ph: (309) 691-7640 | Endocrine & Diabetes, Sc 3308 W Chartwell Rd Peoria IL 61614-2322 Ph: (309) 691-7640 |
| NPI Number | 1053340620 |
|---|---|
| Provider Enumeration Date | 07/03/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 3779624341 |
|---|---|
| Medicare Enrollment ID | O20100104000631 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053340620 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RE0101X | Internal Medicine - Endocrinology, Diabetes & Metabolism | (* (Not Available)) | Primary |
| Provider Name | Jeffrey Y Chang |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1992738728 PECOS PAC ID: 4587705157 Enrollment ID: I20100104000650 |
| Provider Name | Marissa C Myres |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1073917258 PECOS PAC ID: 4789806308 Enrollment ID: I20141117000467 |
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