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Individual

DR. ADOLF M LO

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
208 E SPRINGFIELD AVE, CHAMPAIGN, IL 61820-5462
(217) 352-2212
(217) 352-2215
Mailing address
208 E SPRINGFIELD AVE, CHAMPAIGN, IL 61820-5462
(217) 352-2212
(217) 352-2215

Taxonomy

Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1000280
BLUE SHIELD
IL
Enumeration date
03/01/2007
Last updated
07/08/2007
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