Individual
MR. JEAN MICHEL ELSASSER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
530 NE GLEN OAK AVE, PEORIA, IL 61637-0001
(309) 655-7171
Mailing address
905 S 4TH AVE, MORTON, IL 61550-2547
(309) 251-3672
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085006097
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
345321913
—
IL
Enumeration date
02/08/2017
Last updated
02/08/2017
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