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5401 N Knoxville Ave Ste 306 Peoria IL 61614-5021 | |
| (309) 691-0027 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center |
| Location | 5401 N Knoxville Ave Ste 306, Peoria, Illinois |
| Authorized Official Name and Position | Carrie Chiaravalle (DIRECTOR OPERATIONS) |
| Authorized Official Contact | 3096896043 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
5401 N Knoxville Ave Ste 306 Peoria IL 61614-5021 Ph: () - | 5401 N Knoxville Ave Ste 306 Peoria IL 61614-5021 Ph: (309) 691-0027 |
| NPI Number | 1396923702 |
|---|---|
| Provider Enumeration Date | 02/07/2008 |
| Last Update Date | 02/07/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396923702 | NPI | - | NPPES |
| 07232122 | Other | IL | BCBSIL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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