Individual
DR. JOEL NILLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
VIRGINIA & FRANKLIN STREETS, NORMAL, IL 61761
(309) 827-4321
Mailing address
213 WILLARD AVE, BLOOMINGTON, IL 61701-5652
(309) 310-3994
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
036-099319
IL
207Q00000X
Family Medicine Physician
036099319
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036099319-1
—
IL
01
—
05721369
BC/BS
IL
Enumeration date
06/30/2006
Last updated
06/07/2018
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