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Organization
DECATUR OBGYN ASSOCIATES, LLC
Active
Organization
DECATUR OBGYN ASSOCIATES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROY TSUDA M.D. (VICE PRESIDENT)
(217) 875-5545
Entity
Organization
Contact information
Practice address
1 MEMORIAL DR, SUITE 300, DECATUR, IL 62526-6303
(217) 875-5545
Mailing address
1 MEMORIAL DR, SUITE 300, DECATUR, IL 62526-6303
(217) 875-5545
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
036072402
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020005538
MEDICARE RAILROAD
IL
05
—
036072402
—
IL
05
—
036086221
—
IL
05
—
036087950
—
IL
05
—
036098445
—
IL
05
—
036104247
—
IL
01
—
1396897526
MEDICARE RAILROAD
IL
01
—
160020964
MEDICARE RAILROAD
IL
01
—
160055053
MEDICARE RAILROAD
IL
01
—
160057787
MEDICARE RAILROAD
IL
01
—
CM4913
MEDICARE RAILROAD
IL
Enumeration date
01/17/2007
Last updated
08/07/2008
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