Individual
DR. PENELOPE A EWBANK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
6615 N BIG HOLLOW RD, PEORIA, IL 61615
(309) 691-5200
(309) 691-5201
Mailing address
PO BOX 19248, SPRINGFIELD, IL 62794-9248
(217) 528-7541
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
036104932
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036104932
—
IL
Enumeration date
09/30/2005
Last updated
07/08/2021
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