Individual
JOHN DEFOREST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
715 S DIXIE HWY, BEECHER, IL 60401-3668
(708) 946-9330
(708) 946-2471
Mailing address
715 S DIXIE HWY, BEECHER, IL 60401-3668
(708) 946-9330
(708) 946-2471
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
336051704
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036089998
—
IL
01
—
080154175
RAILROAD MEDICARE
—
01
—
9925692
BC/BS
IL
Enumeration date
06/23/2006
Last updated
12/09/2014
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