Individual
RONALD CHAMPAGNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
210 W WALNUT ST, CANTON, IL 61520-2444
(309) 647-5240
Mailing address
PO BOX 60070, N CHARLESTON, SC 29419-0070
(866) 759-4528
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
036100240
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0361002402
—
IL
01
—
P00005646
RAILROAD MEDICARE
IL
Enumeration date
06/02/2006
Last updated
08/13/2012
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