Individual
DR. JOHNNY C TENEGRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
250 W KENWOOD AVE, DECATUR, IL 62526-4371
(217) 872-3800
(217) 872-0849
Mailing address
250 W KENWOOD AVE, DECATUR, IL 62526-4371
(217) 872-3800
(217) 872-0849
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036-138605
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036138605
—
IL
Enumeration date
06/27/2012
Last updated
12/07/2020
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