| Illinois Gastroenterology Institute, Pllc | |
|
1001 Main St Suite 500a Peoria IL 61606-1907 | |
| (309) 672-4980 | |
| (309) 671-2944 |
| Full Name | Illinois Gastroenterology Institute, Pllc |
|---|---|
| Speciality | Internal Medicine - Gastroenterology |
| Location | 1001 Main St, Peoria, Illinois |
| Authorized Official Name and Position | Mike Shadley (ADMINISTRATOR) |
| Authorized Official Contact | 3096724980 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Illinois Gastroenterology Institute, Pllc Po Box 365 Morton IL 61550-0365 Ph: (309) 672-4980 | Illinois Gastroenterology Institute, Pllc 1001 Main St Suite 500a Peoria IL 61606-1907 Ph: (309) 672-4980 |
| NPI Number | 1275575706 |
|---|---|
| Provider Enumeration Date | 06/11/2006 |
| Last Update Date | 08/17/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275575706 | NPI | - | NPPES |
| 07215152 | Other | IL | BLUE CROSS |
| CE0700 | Other | IL | RAILROAD MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | 042006270 (Illinois) | Primary |
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