Unknown Individual – Family Medicine Physician, NPI 1174614176
Family Medicine Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for Unknown Individual
1120, East War Memorial Drive, Peoria Heights, Peoria, Peoria County, Illinois, 61616, United States
PEORIA HEIGHTS, IL 616167757
Phone: (309) 685-0100
Fax: (309) 685-0172
Type: Mailing
East Washington Street, East Peoria, Tazewell County, Illinois, 61611, United States
EAST PEORIA, IL 616111863
Phone: (309) 694-6464
Fax: (309) 694-6032
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
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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.
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Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
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No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 61616)
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