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Greater Peoria Obstetrics & Gynecology Corp Sc
Specialist in Peoria, Illinois
NPI 1912129271

Greater Peoria Obstetrics & Gynecology Corp Sc is a Specialist based in Peoria, IL. Greater Peoria Obstetrics & Gynecology Corp Sc practices in Peoria, IL. The NPI Number for Greater Peoria Obstetrics & Gynecology Corp Sc is 1912129271 and holds a License No. 03658850 (Illinois).

The current practice location address for Greater Peoria Obstetrics & Gynecology Corp Sc is 4930 N Executive Dr, Peoria, IL and can be reached out via phone at 309-671-8749 and via fax at 309-671-8749.

Location: 4930 N Executive Dr, Peoria, IL, 61614-4894
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1912129271
Provider Name
Greater Peoria Obstetrics & Gynecology Corp Sc
Credential
Provider Entity Type
Organization
Address
4930 N Executive Dr, Peoria, IL, 61614-4894
Phone Number
309-671-8749
Fax Number
309-671-8749
Provider Enumeration Date
05/03/2007
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
212742 01 IL MEDICARE GROUP NUMBER
institution
Provider Business Practice Location Address Details
Address
4930 N Executive Dr
City
Peoria
State
Illinois
Zip
61614-4894
Phone Number
309-671-8749
Fax Number
309-671-8749
person
Provider Business Mailing Address Details
Address
4930 N Executive Dr
City
Peoria
State
Illinois
Zip
61614-4894
Phone Number
309-671-8749
Fax Number
309-671-8749
person
Provider's Taxonomy Details 1
Type
Other Service Providers
Classification
Specialist
Speciality
-
Taxonomy
174400000X
License No.
03658850 (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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