Individual
JOHN LIDVALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
815 MAIN ST, PEORIA, IL 61602-1076
(309) 672-4977
Mailing address
5100 RELIABLE PKWY, CHICAGO, IL 60686-0001
(309) 672-4809
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036132696
IL
Other
Enumeration date
07/16/2010
Last updated
09/15/2020
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