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Individual

MR. DAVID WILLIAM JANTZEN III

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
420 NE GLEN OAK AVE, SUITE 301, PEORIA, IL 61603-3105
(309) 655-3453
(309) 655-3410
Mailing address
420 NE GLEN OAK AVE, SUITE 301, PEORIA, IL 61603-3105
(309) 655-3453
(309) 655-3410

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
4301097945
MI
208000000X
Pediatrics Physician
5841
NE
2080P0202X
Pediatric Cardiology Physician
Primary
036.138159
IL
2080P0202X
Pediatric Cardiology Physician
4301097945
MI

Other

Enumeration date
11/21/2007
Last updated
07/15/2015
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