| Illini Pediatrics, Llc | |
|
1550 N Main St Ste E Columbia IL 62236 | |
| (618) 281-4325 | |
| (618) 208-1313 |
| Full Name | Illini Pediatrics, Llc |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 1550 N Main St Ste E, Columbia, Illinois |
| Authorized Official Name and Position | Joseph E Cangas (MANAGING MEMBER) |
| Authorized Official Contact | 6182814325 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Illini Pediatrics, Llc 1550 N Main St Ste E Columbia IL 62236-1070 Ph: (618) 281-4325 | Illini Pediatrics, Llc 1550 N Main St Ste E Columbia IL 62236 Ph: (618) 281-4325 |
| NPI Number | 1346207784 |
|---|---|
| Provider Enumeration Date | 04/28/2006 |
| Last Update Date | 03/12/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346207784 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 036110913 (Illinois) | Primary |
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