Individual
ADA C SUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1818 E WINDSOR RD, URBANA, IL 61802-9566
(573) 255-9700
(217) 255-9650
Mailing address
611 W PARK ST, BWPC, URBANA, IL 61801-2529
(217) 383-6792
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
036.128652
IL
Other
Enumeration date
07/28/2008
Last updated
05/06/2014
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