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Organization

PREMIER MEDICAL GROUP, LLC

Active
Other names
Katherine Widerborg, M.D.
Organization subpart
No

Provider details

NPI number
Authorized official
MR. JOHN HESSE (EXECUTIVE ADMINISTRATOR)
(309) 662-6200
Entity
Organization

Contact information

Practice address
1537 FORT JESSE RD, SUITE A, NORMAL, IL 61761-6192
(309) 808-0122
(309) 808-0522
Mailing address
1537 FORT JESSE RD, SUITE A, NORMAL, IL 61761-6192
(309) 808-0122
(309) 808-0522

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
36-068927
IL

Other

Enumeration date
03/31/2011
Last updated
03/31/2011
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