Individual
DR. THEODORE REXFORD ADDAI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1770 E LAKE SHORE DR STE 105, DECATUR, IL 62521-3800
(217) 422-6100
(833) 784-5326
Mailing address
1770 E LAKE SHORE DR STE 105, DECATUR, IL 62521-3800
(217) 422-6100
(833) 784-5326
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
036078026
IL
207RC0000X
Cardiovascular Disease Physician
Primary
036078026
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000334245
RAILROAD
IL
05
—
036078026
—
IL
Enumeration date
01/06/2006
Last updated
12/20/2021
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