# PEDIATRIC PROVIDERS OF DANVILLE, LTD

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1659638401
- **Authorized official:** DR. HOLLY MAE MAES MD (PRESIDENT AND MEDICAL DIRECTOR)
- **Authorized official phone:** (217) 442-0433

## Contact information

- **Practice address:** 737 N LOGAN AVE, DANVILLE, IL 61832-4363
- **Practice address phone:** (217) 442-0433
- **Practice address fax:** (217) 442-0485
- **Mailing address:** 737 N LOGAN AVE, DANVILLE, IL 61832-4363
- **Mailing address phone:** (217) 442-0433
- **Mailing address fax:** (217) 442-0485

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | 036113601 | IL | Yes |

## Other

- **Enumeration date:** 04/18/2012
- **Last updated:** 07/01/2013