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Individual

DR. JESSE L VANLE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1505 EASTLAND DR, SUITE 210, BLOOMINGTON, IL 61701-7906
(309) 662-5506
(309) 662-5443
Mailing address
1505 EASTLAND DR, SUITE 210, BLOOMINGTON, IL 61701-7906
(309) 662-5506
(309) 662-5443

Taxonomy

Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
036109293
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
036109293
IL
01
036109293001
OSF HEALTH PLANS
01
05732036
BLUE SHIELD GROUP NUMBER
IL
01
084529
HEALTH ALLIANCE PROVIDER
IL
05
204597405
MO
01
2299329
UNITED HEALTHCARE
01
276560
PERSONAL CARE
01
37875
PHCS
01
37972
TRICARE
01
566399
HEALTHLINK
01
IL0106
JOHN DEERE HEALTH PLAN
Enumeration date
08/25/2005
Last updated
11/01/2012
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