Individual
IAN TAYLOR JUSTEMENT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
611 W PARK ST, URBANA, IL 61801-2529
(217) 383-3285
Mailing address
611 W PARK ST, URBANA, IL 61801-2529
(217) 383-3285
Taxonomy
Speciality
Code
Description
License number
State
2080P0203X
Pediatric Critical Care Medicine Physician
Primary
036.161971
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
OK
Other
Enumeration date
05/17/2016
Last updated
10/24/2022
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