Unknown Individual – Surgery Physician, NPI 1104975978

Unknown Individual is a healthcare provider. based in Watseka, Illinois. specializing in Surgery Physician. They hold a License No. 036126637 (IL). The NPI Number for Unknown Individual is 1104975978

Main info

Organization
Inactive
Name
Unknown Individual
NPI
1104975978
Phone
(815) 432-5411
Address
200 LAIRD LN
Deactivation Date
10 November 2020
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience23
Completeness75
Years active:0State licenses:2Digital endpointsOther names

Provider Addresses for Unknown Individual

  • 200 LAIRD LN

    WATSEKA, IL 609707568

    Phone: (815) 432-5411

    Fax: (815) 432-3955

    Type: Location

  • Iroquois Memorial Hospital, 200, East Fairman Avenue, Watseka, Iroquois County, Illinois, 60970, United States

    WATSEKA, IL 609701644

    Phone: (815) 432-5841

    Type: Mailing

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 60970)

Loading plans...

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 Unknown Individual's NPI number?
Unknown Individual's NPI is 1104975978 — the number used across U.S. healthcare to identify this provider.
Is inactive the same as retired for Unknown Individual?
Inactive registry status can reflect deactivation, consolidation, or data lag.
What kind of doctor is Unknown Individual?
Unknown Individual is associated with Surgery Physician in the directory — Clinical services aligned with this taxonomy classification.
What locale is associated with Unknown Individual?
Directory geography for Unknown Individual centers on Watseka, Illinois.
Does inactive status remove historical data?
Historical rows can remain visible after status changes — read the dates carefully.