Organization
BOCHANTIN OBSTETRICS & GYNECOLOGY SERVICES LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARLA TOMLINSON (OFFICE MANAGER)
(309) 692-5100
Entity
Organization
Contact information
Practice address
5401 N KNOXVILLE AVE, SUITE 308, PEORIA, IL 61614-5098
(309) 692-5100
(309) 692-1400
Mailing address
5401 N KNOXVILLE AVE, SUITE 308, PEORIA, IL 61614-5098
(309) 692-5100
(309) 692-1400
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
036098292
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036098292
—
IL
01
—
09032023
BLUECROSS BLUESHIELD
IL
01
—
447752
HEALTHLINK
IL
Enumeration date
03/29/2007
Last updated
09/07/2011
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