Individual
EMMANUELLA JOSEPH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
600 S 13TH ST, SUITE M, PEKIN, IL 61554-4936
(309) 346-8038
Mailing address
PO BOX 2077, DECATUR, IL 62524-2077
(217) 876-9987
(217) 876-1792
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
09015685
BLUE CROSS BLUE SHIELD
IL
Enumeration date
06/15/2006
Last updated
03/24/2008
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