Individual
DR. GLEN J SIDLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
201 N CUMMINGS LN, WASHINGTON, IL 61571-2181
(309) 444-2005
(309) 444-2006
Mailing address
201 N CUMMINGS LN, P.O. BOX 310, WASHINGTON, IL 61571-2181
(309) 444-2005
(309) 444-2006
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
036060332
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036060332
—
IL
01
—
1043298557
NPI
IL
Enumeration date
01/04/2006
Last updated
10/29/2014
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