Individual
PATRICK S FERNANDES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
407 E VERNON AVE, NORMAL, IL 61761-3813
(309) 451-2231
(309) 451-2299
Mailing address
611 W. PARK ST, FAPC, URBANA, IL 61801
(309) 451-2231
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
036102220
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036102220
—
IL
Enumeration date
04/07/2006
Last updated
03/24/2021
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