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Individual

DR. WILLIAM EDMUND FLETCHALL

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
530 NE GLEN OAK AVE, PEORIA, IL 61637-0001
(309) 655-6710
Mailing address
7501 N VILLA LAKE DR UNIT 9A, PEORIA, IL 61614-8280
(309) 691-5133

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
036118956
IL
207P00000X
Emergency Medicine Physician
125-049796
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0361189564
IL
01
36118956
BCBS
IL
01
P00655422
RAILROAD MCARE THRU CES
IL
01
P00936448
RRMCARE THRU CESIISC (GES)
IL
Enumeration date
05/21/2007
Last updated
08/17/2011
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