Individual
BRIAN BOSTWICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
301 N 8TH ST, PAV 4A, SPRINGFIELD, IL 62702
(217) 545-8000
(217) 545-2303
Mailing address
530 NE GLEN OAK AVE, PEORIA, IL 61637-0001
(309) 655-3292
(309) 655-7732
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
036106503
IL
208000000X
Pediatrics Physician
Primary
036106503
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036106503
—
IL
01
—
07215036
BCBS
IL
01
—
IL0104
JOHN DEERE
IL
Enumeration date
02/10/2006
Last updated
10/20/2020
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