Individual
JENECSIS CASTRO-SKOGLUND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5401 N KNOXVILLE AVE, SUITE 114, PEORIA, IL 61614-5098
(309) 689-8370
(309) 689-8380
Mailing address
5401 N KNOXVILLE AVE, SUITE 114, PEORIA, IL 61614-5098
(309) 689-8370
(309) 689-8380
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036093944
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036093944
—
IL
01
—
055562
HEALTH ALLIANCE
IL
01
—
07232028
BLUE CROSS BLUE SHIELD
IL
01
—
383653744
TAX ID
IL
01
—
IL0101
JOHN DEERE
IL
Enumeration date
08/31/2006
Last updated
11/13/2007
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