Individual
DR. DEAN R. COLLETTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
800 E CARPENTER ST, DEPARTMENT OF RADIOLOGY, SPRINGFIELD, IL 62702-5324
(217) 544-6464
(217) 525-5671
Mailing address
111 OAKWOOD RD, EAST PEORIA, IL 61611-1853
(309) 740-4272
Taxonomy
Speciality
Code
Description
License number
State
2085R0204X
Vascular & Interventional Radiology Physician
Primary
036106391
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
300131923
RR MEDICARE
IL
01
—
300131924
RR MEDICARE
IL
05
—
36106391
—
IL
Enumeration date
08/16/2006
Last updated
11/29/2023
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