Individual
JARED WILLARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3101 FIELDS SOUTH DR, CHAMPAIGN, IL 61822-3743
(217) 366-1237
(217) 366-1303
Mailing address
101 W UNIVERSITY AVE, CHAMPAIGN, IL 61820-3981
(217) 366-2632
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
0000058974
TN
207RS0010X
Sports Medicine (Internal Medicine) Physician
0000058974
TN
207RS0010X
Sports Medicine (Internal Medicine) Physician
Primary
036155928
IL
Other
Enumeration date
04/04/2015
Last updated
06/03/2025
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