Organization
GREATER PEORIA OBSTETRICS & GYNECOLOGY CORP SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUDY MUELLER (MANAGER)
(309) 692-7575
Entity
Organization
Contact information
Practice address
4930 N EXECUTIVE DR, PEORIA, IL 61614-4894
(309) 671-8749
(309) 671-8749
Mailing address
4930 N EXECUTIVE DR, PEORIA, IL 61614-4894
(309) 692-7575
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
03658850
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
212742
MEDICARE GROUP NUMBER
IL
Enumeration date
05/03/2007
Last updated
05/01/2015
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