Organization
ILLINI CARES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHAD BEENE (MANAGER)
(215) 915-1020
Entity
Organization
Contact information
Practice address
3631 S 6TH ST, SUITE D, SPRINGFIELD, IL 62703-4777
(217) 391-5446
Mailing address
3631 S 6TH ST, SUITE D, SPRINGFIELD, IL 62703-4777
(217) 391-5446
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
036119004
IL
Other
Enumeration date
10/17/2016
Last updated
04/27/2017
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