Individual
DANIEL J NIEBRUGGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
301 N 8TH ST STE 4A, SPRINGFIELD, IL 62701-1013
(217) 545-8000
(217) 545-4788
Mailing address
PO BOX 19658, SPRINGFIELD, IL 62794-9658
(217) 545-8000
(217) 545-4788
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
036-113085
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036113085
—
IL
Enumeration date
12/05/2005
Last updated
10/09/2018
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