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Dr. Herman Justis Dick JR., MD
Specialist in Bloomington, Illinois
NPI 1891891370

Herman Justis Dick JR. is a Specialist based in Bloomington, IL. Herman Justis Dick JR. practices in Bloomington, IL and has the professional credentials of MD. The NPI Number for Herman Justis Dick JR. is 1891891370 and holds a License No. 036056374 (Illinois).

The current practice location address for Herman Justis Dick JR. is 2204 Eastland Dr, Bloomington, IL and can be reached out via phone at 309-662-9461 and via fax at 309-663-0222.

Location: 2204 Eastland Dr, Bloomington, IL, 61704-3566
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1891891370
Provider Name
Herman Justis Dick JR.
Credential
MD
Provider Entity Type
Individual
Gender
Male
Address
2204 Eastland Dr, Bloomington, IL, 61704-3566
Phone Number
309-662-9461
Fax Number
309-663-0222
Provider Enumeration Date
09/15/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
5715381 01 IL BLUE CROSS BLUE SHIELD
130005238 01 IL MEDICARE ID
036056374 05 IL
institution
Provider Business Practice Location Address Details
Address
2204 Eastland Dr
City
Bloomington
State
Illinois
Zip
61704-3566
Phone Number
309-662-9461
Fax Number
309-663-0222
person
Provider Business Mailing Address Details
Address
2204 Eastland Dr
City
Bloomington
State
Illinois
Zip
61704-3566
Phone Number
309-662-9461
Fax Number
309-663-0222
person
Provider's Taxonomy Details 1
Type
Other Service Providers
Classification
Specialist
Speciality
-
Taxonomy
174400000X
License No.
036056374 (Illinois)
Definition
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
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