| Peoria Integrative Medical Center Ltd | |
|
4930 N Executive Dr Suite B Peoria IL 61614-4894 | |
| (309) 683-6002 | |
| (309) 683-6007 |
| Full Name | Peoria Integrative Medical Center Ltd |
|---|---|
| Speciality | Family Medicine |
| Location | 4930 N Executive Dr, Peoria, Illinois |
| Authorized Official Name and Position | Yang Xie (OWNER) |
| Authorized Official Contact | 3096367302 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Peoria Integrative Medical Center Ltd 4930 N Executive Dr Suite B Peoria IL 61614-4894 Ph: (309) 683-6002 | Peoria Integrative Medical Center Ltd 4930 N Executive Dr Suite B Peoria IL 61614-4894 Ph: (309) 683-6002 |
| NPI Number | 1699839985 |
|---|---|
| Provider Enumeration Date | 12/20/2006 |
| Last Update Date | 04/20/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699839985 | NPI | - | NPPES |
| 036114042 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 036114042 (Illinois) | Primary |
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