Individual
MR. KAMLESH SAMSON MACWAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
530 NE GLEN OAK AVE, ST FRANCIS MEDICAL CENTER, PEORIA, IL 61637
(309) 655-2485
(309) 655-2874
Mailing address
PO BOX 1186, PEKIN, IL 61555-1186
(309) 353-4483
(309) 353-7713
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
53948
IL
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
3248
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
004082
HEALTH ALLIANCE
IL
05
—
03608163702
—
IL
01
—
7215111
BLUE CROSS BLUE SHIELD
IL
01
—
IL0105
JOHN DEERE
IL
Enumeration date
07/30/2006
Last updated
09/11/2025
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