Individual
DR. TED G VAN ACKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
220 N PARK AVE, SUITE 2, HERRIN, IL 62948-3150
(618) 942-3344
(618) 942-5045
Mailing address
220 N PARK AVE, SUITE 2, HERRIN, IL 62948-3150
(618) 942-3344
(618) 942-5045
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10007459
BCBS GROUP NUMBER
IL
01
—
290730
HEALTHLINK PROV NUMBER
IL
01
—
CB3700
RAILROAD MEDICARE GRP #
IL
01
—
L84853
UMWA PROVIDER NUMBER
IL
Enumeration date
06/01/2006
Last updated
07/08/2007
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