Organization
BLUEZE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOEL NILLES DO (SOLE MBR)
(309) 585-2116
Entity
Organization
Contact information
Practice address
2412 E WASHINGTON ST, SUITE 6, BLOOMINGTON, IL 61704-4497
(309) 585-2116
(309) 585-2152
Mailing address
2412 E WASHINGTON ST, SUITE 6, BLOOMINGTON, IL 61704-4497
(309) 585-2116
(309) 585-2152
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036099319
IL
Other
Enumeration date
04/27/2017
Last updated
04/27/2017
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