Individual
ANDREW JOHN SHADRACH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
530 NE GLEN OAK AVE, PEORIA, IL 61637-1003
(309) 655-2000
Mailing address
624 NE GLEN OAK AVE ROOM 2670, PEORIA, IL 61637-0001
(309) 655-3971
(309) 655-3630
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036162030
IL
Other
Enumeration date
03/19/2018
Last updated
06/28/2023
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