ST MARYS HOSPITAL DECATUR OF THE HOSPITAL SISTERS OF THE THIRD ORDER
Organization (NPI-2)
Active
Physician Assistant
Provider Information
- NPI Number
1174702708- Provider Type
- Organization / Facility (NPI-2)
- Status
- Active
Contact & Location
- Address
- 1900 E LAKE SHORE DR SUITE 200, DECATUR, IL, 625213824
- Phone
- (217) 464-1030
- Fax
- (217) 464-1039
Specialties & Taxonomies
Physician Assistant
Primary License: IL #085-003034