Unknown Individual – Physician Assistant, NPI 1649241373
Physician Assistant
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for Unknown Individual
North Knoxville Avenue, Keller, Peoria, Peoria County, Illinois, 61615, United States
PEORIA, IL 616142017
Phone: (309) 589-5900
Fax: (309) 683-4120
Mailing address matches the actual address.
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
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No Medicare enrollment or revalidation data available for this provider in our database.
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Medicare Utilization (FFS)
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No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 61614)
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