Individual
TRAVIS EDWARD TWEEDY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
10700 OLD STATE RD, CARLYLE, IL 62231-6502
(618) 795-0351
Mailing address
10700 OLD STATE RD, CARLYLE, IL 62231-6502
(618) 795-0351
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
IL
Other
Enumeration date
09/18/2025
Last updated
09/18/2025
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