Full Name | |
---|---|
Speciality | General Practice |
Location | 200 Laird Ln, Watseka, Illinois |
Authorized Official Name and Position | Dennis Wittenborn (BOARD CHAIRMAN) |
Authorized Official Contact | 8154325841 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
200 Laird Ln Watseka IL 60970-7568 Ph: (815) 432-5841 | 200 Laird Ln Watseka IL 60970-7568 Ph: (815) 432-5841 |
NPI Number | 1134445851 |
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Provider Enumeration Date | 04/20/2010 |
Last Update Date | 04/20/2010 |
Identifier | Type | State | Issuer |
---|---|---|---|
1134445851 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
208D00000X | General Practice | (* (Not Available)) | Primary |
Gonzalo T Florido Md Sc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 714 S 10th St, Watseka, IL 60970 Phone: 815-432-6744 | |