Organization
MIDWEST EAR NOSE & THROAT ASSOCIATES S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JAN L GOLD (OFFICE ADMINISTRATOR)
(309) 691-6359
Entity
Organization
Contact information
Practice address
8600 N STATE RT 91, STE 300, PEORIA, IL 61615
(309) 691-6616
(309) 691-2943
Mailing address
8600 N STATE ROUTE 91, STE 300, PEORIA, IL 61615-9541
(309) 691-6616
(309) 691-2943
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
—
—
Other
Enumeration date
06/26/2006
Last updated
04/27/2012
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