| Dr Kody Duane Dormire, DO | |
|
530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | |
| (309) 655-4940 | |
| Not Available |
| Full Name | Dr Kody Duane Dormire |
|---|---|
| Gender | Male |
| Speciality | Internal Medicine |
| Location | 530 Ne Glen Oak Ave, Peoria, Illinois |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083241293 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208000000X | Pediatrics | 036162380 (Illinois) | Secondary |
| 207R00000X | Internal Medicine | 036162380 (Illinois) | Primary |
| Entity Name | Osf Multi-specialty Group |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1922445527 PECOS PAC ID: 3678889789 Enrollment ID: O20150904000279 |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Kody Duane Dormire, DO 400 E Cedar St, Perry, OK 73077-7833 Ph: (580) 336-7670 | Dr Kody Duane Dormire, DO 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 Ph: (309) 655-4940 |
Riaz Shah, MD Internal Medicine Medicare: May Accept Medicare Assignments Practice Location: 221 Ne Glen Oak Ave, Suite 504, Peoria, IL 61636 Phone: 309-672-5729 | |
Dr. James Daniel Dewar, D.O. Internal Medicine Medicare: Accepting Medicare Assignments Practice Location: 530 Ne Glen Oak Ave, Peoria, IL 61637 Phone: 309-655-7257 | |
Waqas Ali, MD Internal Medicine Medicare: Not Enrolled in Medicare Practice Location: 221 Ne Glen Oak Ave, Peoria, IL 61636 Phone: 309-672-5522 | |
Dr. Sudhir Mungee, MD Internal Medicine Medicare: Accepting Medicare Assignments Practice Location: 5405 North Knoxville Avenue, Peoria, IL 61614 Phone: 309-691-4410 Fax: 309-589-2830 | |
Kumarpal Shrishrimal, MD Internal Medicine Medicare: Accepting Medicare Assignments Practice Location: 420 Ne Glen Oak Ave Ste 401, Peoria, IL 61603 Phone: 309-676-8123 Fax: 309-676-8455 | |
Dr. Nikesh Kavi Patel, MD Internal Medicine Medicare: Medicare Enrolled Practice Location: 530 Ne Glen Oak Ave, Peoria, IL 61637 Phone: 309-655-6384 Fax: 309-655-7732 | |
Christine C Perks, MD Internal Medicine Medicare: Accepting Medicare Assignments Practice Location: 5405 N Knoxville Ave, Peoria, IL 61614 Phone: 309-691-4410 Fax: 309-692-4730 |