Registry details
Type
Individual
Primary specialty
Anesthesiology
Enumerated
Mar 21, 2013
License(s)
65758 (MN), 125062746 (IL), 036157596 (IL)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 611 W PARK ST | Urbana, IL 61801-2529 | 217-383-3311 |
| MAILING | 611 W PARK ST | Urbana, IL 61801-2529 | 217-383-3311 |
Watch this provider
Get a webhook/email the day this provider is added to the OIG-LEIE exclusion list or appears in an FDA enforcement action.