Unknown Individual – Cardiovascular Disease Physician, NPI 1366494544

Unknown Individual is a healthcare provider. based in Normal, Illinois. specializing in Cardiovascular Disease Physician. The NPI Number for Unknown Individual is 1366494544

Main info

Organization
Inactive
54 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1366494544
Phone
(309) 828-1166
Address
1302 FRANKLIN AVE
Deactivation Date
25 January 2023

Doctor Profile

Medical School Name
OTHER
Secondary Phone
8474591160
Graduation Year
1972 (54 years ago)
PAC ID
0648203539
Group Practice PAC ID
7810800935
Professional Enrollment ID
I20050912001023
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience5
Completeness75
Years active:0State licenses:0Digital endpointsOther names

Loading map...

Provider Addresses for Unknown Individual

  • 1302, Franklin Avenue, Normal, McLean County, Illinois, 61701, United States

    4500

    NORMAL, IL 617613551

    Phone: (309) 828-1166

    Fax: (309) 862-0330

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

Loading prescription activity...

Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 61761)

Loading plans...

Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 7810800935View full group profile

Reviews

All reviews are moderated before publication. Reviews reflect users' opinions; we do not verify the accuracy of individual reviews.

No reviews yet. Be the first to share your experience — your opinion helps families compare providers.

Frequently asked questions

What is the 10-digit NPI for Unknown Individual?
Unknown Individual — NPI 1366494544 — is the standard way to identify this listing.
What dates should I check for Unknown Individual's activity?
We display what the registry publishes: Unknown Individual appears inactive there.
What healthcare role does Unknown Individual hold?
Scheduling teams often label Unknown Individual under Cardiovascular Disease Physician. Clinical services aligned with this taxonomy classification.
Where should I expect Unknown Individual on a map?
Expect Normal, Illinois as a primary anchor for Unknown Individual unless the record lists multiple sites.
Is specialty guaranteed by NPI alone?
Taxonomy selections describe intent; scope of practice still follows state law.

Similar Providers

MR. CHRISTOPHER L. NELSON (PA)

Surgical Physician Assistant
1302 FRANKLIN AVE STE 4500
NPI: 1114911971

DR. MUMTAZ A SIDDIQUI (M.D.)

Cardiovascular Disease Physician
1302, Franklin Avenue, Old East Side, Normal, McLean County, Illinois, 61761, United States
NPI: 1679569925

DR. ROBERT A. BRAASTAD (M.D.)

Cardiovascular Disease Physician
611 W. PARK ST
NPI: 1487619573

DR. DORY C JARZABKOWSKI (D.O.)

Cardiovascular Disease Physician
1302, Franklin Avenue, Normal, McLean County, Illinois, 61701, United States
NPI: 1083651939

DR. SAMIR H. SHAH (M.D.)

Cardiovascular Disease Physician
1302, Franklin Avenue, Normal, McLean County, Illinois, 61701, United States
NPI: 1720028632

BETH L TUMILTY (DO)

Cardiovascular Disease Physician
1302, Franklin Avenue, Normal, McLean County, Illinois, 61701, United States
NPI: 1033159959

DR. THANOM TEMIYASATHIT (M.D.)

Cardiovascular Disease Physician
1302, Franklin Avenue, Normal, McLean County, Illinois, 61701, United States
NPI: 1023041175

Illinois Heart & Lung Associates

Cardiovascular Disease Physician
1302, Franklin Avenue, Normal, McLean County, Illinois, 61701, United States
NPI: 1225061393

DR. KELLEY DALE KENNEDY (M.D.)

Cardiovascular Disease Physician
1300 Franklin Ave
NPI: 1235148339