Active NPI 1568412773 Individual Practitioner Male Practitioner

Dr. Thomas F. Kouri , MD

Internal Medicine • Peoria, IL

✓ Accepts Medicare Assignment

Professional Overview & Biography Verified Profile Summary

Dr. Thomas Kouri, MD is a certified Internal Medicine practicing in Peoria, IL. With approximately 44 years of clinical experience since graduating from Saint Louis University School Of Medicine in 1982, Dr. Kouri delivers high-quality medical care to the local community at 5401 N KNOXVILLE AVE.

Dr. Kouri maintains professional affiliations with Select Rehabilitation, Llc, Proctor Health Systems, Carle Health Care Incorporated and accepts Medicare assignment.

Frequently performed procedures and clinical services include established patient outpatient office visit, subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least, subsequent hospital care with moderate levelof medical decision making, if using time, at least. Full Medicare procedure pricing transparency rates and service volume details are listed on this profile.

Practice Location & Contact Primary Location

Practice Address

5401 N Knoxville Ave
Suite 204

Peoria, IL 616145098

Telephone 3096899088

Fax 3096891037

Associated Practice Facility / Clinic

🏢 Frank I Russo Facility NPI 1639140833

Medicare Profile & Education

Medical School

Saint Louis University School Of Medicine

Graduation Year

1982

Medicare Assignment

✓ Accepts Assignment

Telehealth Flag

In-Person Only

Specialty Benchmarks & Practice Insights

Comparative analytics for Internal Medicine in Peoria, IL

Senior Veteran Specialist (>20 Yrs)

Practitioner Clinical Experience

44 Yrs +26.5 yrs vs City Avg

City Avg: 17.5 Yrs

State Avg: 28.9 Yrs

Regional Practice Density

176 Specialists

Practicing in Peoria, IL (7544 Statewide)

Telehealth Adoption Rate

12.5% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount

59.8% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Clinical Seniority & Experience Comparison

Dr. Kouri (44 Years) 44 Yrs

Peoria Specialty Average (17.5 Years) 17.5 Yrs

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2024)

Reporting Year:

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	790	389	$260.00	$122.32
99309 Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes	295	68	$230.00	$103.28
99232 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	289	82	$195.00	$75.98
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	157	23	$17.23	$0.99
G0439 Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	105	105	$315.00	$123.47
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	85	21	$61.00	$13.48
99239 Hospital discharge day management, more than 30 minutes	85	62	$280.00	$108.77
99223 Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes	81	65	$445.00	$167.48
G0008 Administration of influenza virus vaccine	63	63	$61.00	$31.15
90662 Influenza vaccine split virus, preservative free	61	61	$172.10	$81.17
36415 Insertion of needle into vein for collection of blood sample	59	53	$10.00	$8.65
99213 Established patient office or other outpatient visit, typically 15 minutes	39	33	$185.00	$86.74
99306 Initial nursing facility visit, typically 45 minutes per day	37	33	$445.00	$175.11
99307 Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, at least 10 minutes	27	27	$97.00	$38.61
20610 Aspiration and/or injection of fluid from large joint	15	12	$228.00	$69.18

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	835	389	$242.49	$122.46
99232 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	322	93	$184.00	$77.34
99309 Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes	279	75	$216.00	$103.10
G0439 Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	223	223	$299.00	$123.39
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	204	28	$4.15	$1.08
36415 Insertion of needle into vein for collection of blood sample	137	107	$8.39	$8.06
99239 Hospital discharge day management, more than 30 minutes	94	73	$265.00	$111.53
99213 Established patient office or other outpatient visit, typically 15 minutes	83	69	$171.34	$86.73
99223 Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes	81	66	$422.22	$169.48
90662 Influenza vaccine split virus, preservative free	69	69	$95.32	$71.93
G0008 Administration of influenza virus vaccine	69	69	$58.00	$29.66
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	59	16	$54.47	$13.46
99306 Initial nursing facility visit, typically 45 minutes per day	39	31	$423.00	$176.75
99309 Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes	37	29	$216.00	$103.06
20610 Aspiration and/or injection of fluid from large joint	21	15	$228.10	$71.48
99308 Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, at least 15 minutes	21	15	$172.00	$72.18

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	917	429	$244.00	$123.89
99232 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	414	90	$169.00	$69.50
99309 Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes	368	85	$214.00	$87.47
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	286	30	$3.00	$1.12
G0439 Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	243	243	$311.00	$125.54
36415 Insertion of needle into vein for collection of blood sample	111	87	$8.00	$2.93
G0008 Administration of influenza virus vaccine	83	83	$50.00	$28.00
99239 Hospital discharge day management, more than 30 minutes	79	58	$249.00	$101.72
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	76	25	$45.00	$13.03
99223 Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes	76	62	$469.00	$193.18
90662 Influenza vaccine split virus, preservative free	74	74	$85.00	$68.54
99306 Initial nursing facility visit, typically 45 minutes per day	65	53	$390.00	$159.89
99213 Established patient office or other outpatient visit, typically 15 minutes	51	47	$172.00	$86.58
99225 Subsequent observation care, typically 25 minutes per day	41	21	$168.00	$68.01
20610 Aspiration and/or injection of fluid from large joint	33	21	$221.09	$78.01
99318 Nursing facility annual assessment, typically 30 minutes	32	32	$225.00	$92.11
99217 Hospital observation care on day of discharge	23	19	$169.00	$67.11
99219 Hospital observation care, typically 50 minutes	19	14	$313.00	$124.43
0134A Fee covid-19 vac 14 res	12	12	$80.00	$36.95
G0009 Administration of pneumococcal vaccine	12	12	$50.00	$28.34
G0402 Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment	12	12	$398.00	$162.78

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	1,005	458	$228.00	$126.38
99232 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	649	123	$156.00	$70.76
G0439 Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	239	239	$290.00	$127.38
99309 Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes	201	67	$198.00	$88.76
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	144	11	$4.00	$1.26
99239 Hospital discharge day management, more than 30 minutes	123	91	$230.00	$104.12
99223 Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes	117	96	$434.00	$197.15
G0008 Administration of influenza virus vaccine	88	88	$49.00	$16.21
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	85	17	$45.00	$13.66
99213 Established patient office or other outpatient visit, typically 15 minutes	78	64	$160.00	$89.26
90662 Influenza vaccine split virus, preservative free	76	76	$78.00	$64.34
99309 Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes	73	42	$198.00	$88.76
99225 Subsequent observation care, typically 25 minutes per day	69	34	$154.84	$69.96
99217 Hospital observation care on day of discharge	55	47	$156.00	$69.37
0064A Adm sarscov2 50mcg/0.25mlbst	50	50	$80.00	$38.01
20610 Aspiration and/or injection of fluid from large joint	43	25	$210.12	$81.20
99219 Hospital observation care, typically 50 minutes	37	32	$287.97	$132.38
36415 Insertion of needle into vein for collection of blood sample	34	25	$8.00	$3.00
99306 Initial nursing facility visit, typically 45 minutes per day	33	30	$361.00	$163.07
99318 Nursing facility annual assessment, typically 30 minutes	23	23	$208.00	$93.48
99306 Initial nursing facility visit, typically 45 minutes per day	16	16	$361.00	$163.07
90686 Vaccine for influenza for administration into muscle, 0.5 ml dosage	15	15	$34.00	$20.53
99222 Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes	12	11	$294.00	$134.10

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	978	465	$207.00	$105.89
99232 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	619	148	$175.00	$71.90
G0439 Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	331	331	$276.00	$111.92
99309 Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes	259	79	$218.00	$90.28
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	225	25	$8.00	$1.51
99239 Hospital discharge day management, more than 30 minutes	153	111	$256.00	$105.52
99223 Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes	151	117	$486.00	$201.30
G0008 Administration of influenza virus vaccine	100	98	$48.00	$16.15
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	85	18	$42.00	$13.53
90662 Influenza vaccine split virus, preservative free	84	83	$86.00	$60.91
G0009 Administration of pneumococcal vaccine	78	78	$48.00	$16.03
99213 Established patient office or other outpatient visit, typically 15 minutes	70	63	$141.00	$72.40
36415 Insertion of needle into vein for collection of blood sample	54	38	$8.00	$2.99
90670 Pneumococcal vaccine for injection into muscle	47	47	$377.00	$219.50
99318 Nursing facility annual assessment, typically 30 minutes	42	41	$231.00	$95.76
99225 Subsequent observation care, typically 25 minutes per day	39	23	$175.00	$72.64
99217 Hospital observation care on day of discharge	39	32	$174.00	$72.05
20610 Aspiration and/or injection of fluid from large joint	39	24	$192.79	$73.66
99306 Initial nursing facility visit, typically 45 minutes per day	38	37	$400.00	$165.53
99219 Hospital observation care, typically 50 minutes	37	34	$326.92	$135.56
90732 Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle, patient 2 years or older	34	34	$135.00	$117.81
99308 Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, at least 15 minutes	31	24	$166.00	$68.33
99309 Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes	26	11	$218.00	$89.89
99236 Initial hospital care with same-day admission and discharge with high level of medical decision making, per day, if using time, at least 85 minutes	23	18	$524.00	$218.09
99306 Initial nursing facility visit, typically 45 minutes per day	18	18	$400.00	$165.41
90686 Vaccine for influenza for administration into muscle, 0.5 ml dosage	17	17	$34.00	$18.10
G0402 Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment	13	13	$397.00	$162.81

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	1,100	474	$207.00	$104.62
99232 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	872	221	$175.00	$71.66
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	354	37	$9.00	$1.57
99309 Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes	300	81	$219.00	$89.91
99239 Hospital discharge day management, more than 30 minutes	225	166	$257.00	$104.76
99213 Established patient office or other outpatient visit, typically 15 minutes	181	132	$141.00	$71.40
99223 Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes	178	143	$486.00	$198.92
G0008 Administration of influenza virus vaccine	120	118	$48.00	$15.85
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	117	31	$39.00	$15.35
90686 Vaccine for influenza for administration into muscle, 0.5 ml dosage	98	98	$34.00	$18.65
99308 Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, at least 15 minutes	87	48	$165.00	$67.58
G0009 Administration of pneumococcal vaccine	87	87	$48.00	$15.85
99225 Subsequent observation care, typically 25 minutes per day	63	35	$176.00	$72.16
99219 Hospital observation care, typically 50 minutes	57	51	$326.00	$132.35
20610 Aspiration and/or injection of fluid from large joint	56	33	$171.21	$72.68
99306 Initial nursing facility visit, typically 45 minutes per day	50	45	$401.00	$164.01
99217 Hospital observation care on day of discharge	50	45	$175.00	$71.78
99318 Nursing facility annual assessment, typically 30 minutes	48	48	$230.00	$94.45
90670 Pneumococcal vaccine for injection into muscle	47	47	$377.00	$206.10
G0439 Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	44	44	$276.00	$111.77
90732 Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle, patient 2 years or older	42	42	$132.00	$111.63
36415 Insertion of needle into vein for collection of blood sample	32	26	$8.00	$2.94
90662 Influenza vaccine split virus, preservative free	22	21	$86.00	$54.42
99236 Initial hospital care with same-day admission and discharge with high level of medical decision making, per day, if using time, at least 85 minutes	19	17	$524.00	$214.87
99306 Initial nursing facility visit, typically 45 minutes per day	15	13	$401.00	$163.91
99222 Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes	12	12	$328.00	$135.45

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	1,180	497	$198.98	$103.98
99232 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	676	202	$169.55	$71.66
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	435	38	$7.85	$1.81
99309 Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes	354	79	$200.81	$90.11
99239 Hospital discharge day management, more than 30 minutes	190	148	$244.97	$105.56
99223 Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes	151	126	$458.13	$198.77
99213 Established patient office or other outpatient visit, typically 15 minutes	146	111	$134.32	$70.69
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	115	32	$47.19	$19.34
G0008 Administration of influenza virus vaccine	92	92	$48.00	$19.39
90662 Influenza vaccine split virus, preservative free	91	91	$86.00	$51.73
20610 Aspiration and/or injection of fluid from large joint	63	32	$191.25	$62.86
99308 Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, at least 15 minutes	63	36	$147.29	$68.14
99306 Initial nursing facility visit, typically 45 minutes per day	62	51	$352.13	$164.54
99217 Hospital observation care on day of discharge	47	45	$164.98	$71.96
99219 Hospital observation care, typically 50 minutes	45	43	$311.93	$134.79
G0009 Administration of pneumococcal vaccine	45	45	$41.40	$18.13
99318 Nursing facility annual assessment, typically 30 minutes	42	41	$201.93	$95.00
99225 Subsequent observation care, typically 25 minutes per day	35	25	$160.89	$72.32
36415 Insertion of needle into vein for collection of blood sample	35	20	$10.57	$2.94
99222 Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes	32	29	$315.75	$135.69
90732 Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle, patient 2 years or older	26	26	$94.38	$88.99
90670 Pneumococcal vaccine for injection into muscle	19	19	$308.63	$200.37

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	1,231	511	$167.67	$102.89
99232 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	563	198	$150.62	$71.07
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	430	44	$5.00	$1.77
99309 Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes	343	81	$153.00	$89.38
99223 Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes	235	207	$363.46	$199.93
36415 Insertion of needle into vein for collection of blood sample	221	149	$18.00	$2.92
99239 Hospital discharge day management, more than 30 minutes	180	154	$190.54	$104.66
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	101	25	$45.00	$22.54
99213 Established patient office or other outpatient visit, typically 15 minutes	100	76	$111.98	$69.79
G0008 Administration of influenza virus vaccine	82	82	$25.00	$23.48
20610 Aspiration and/or injection of fluid from large joint	76	35	$217.32	$55.45
99219 Hospital observation care, typically 50 minutes	67	66	$236.96	$133.85
99306 Initial nursing facility visit, typically 45 minutes per day	59	47	$219.00	$163.58
99217 Hospital observation care on day of discharge	54	49	$138.33	$71.39
99233 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes	53	27	$206.00	$99.93
90686 Vaccine for influenza for administration into muscle, 0.5 ml dosage	47	47	$25.00	$18.25
99308 Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, at least 15 minutes	40	23	$108.00	$67.60
99318 Nursing facility annual assessment, typically 30 minutes	39	38	$146.00	$94.62
99225 Subsequent observation care, typically 25 minutes per day	37	30	$113.19	$71.72
G0009 Administration of pneumococcal vaccine	35	35	$15.00	$14.70
90662 Influenza vaccine split virus, preservative free	32	32	$91.00	$46.55
90670 Pneumococcal vaccine for injection into muscle	26	26	$320.00	$178.91
99222 Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes	24	22	$278.75	$135.19
99309 Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes	18	15	$153.00	$89.29
99306 Initial nursing facility visit, typically 45 minutes per day	15	15	$219.00	$163.56
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	13	13	$258.15	$159.69
99220 Hospital observation care, typically 70 minutes	12	12	$313.00	$182.96

Medical Specialties & State Licenses

Internal Medicine Primary Specialty

NUCC Taxonomy Code: 207R00000X

State License IL 036071029

A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.

Additional State Medicaid & Healthcare Payer Identifiers

Medicaid State Provider ID

036071029 (IL)

Commercial Insurance / Payer ID Railroad Medicare

110228165 (IL)

Hospital & Practice Group Affiliations

Carle Health Care Incorporated

5401 N Knoxville Ave, Peoria, IL 616145021

Proctor Health Systems

5401 N Knoxville Ave, Peoria, IL 616145021

Carle Health Care Incorporated

611 W Park St, Urbana, IL 618012501

Methodist Medical Center Of Illinois

221 Ne Glen Oak Ave, Peoria, IL 616360001

Phone: 3096725729

Select Rehabilitation, Llc

2600 Compass Rd, Glenview, IL 600268001

Carle Health Care Incorporated

611 W Park St, Urbana, IL 618012501

Phone: 8887122753

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

40 Associated Practitioners

Dr. Yibing Li , MD

Physical Medicine & Rehabilitation

NPI 1013923929

Doctor of Medicine (M.D.)

Barbara Nall , APN

Nurse Practitioner - Women's Health

NPI 1053383471

Advanced Practice Nurse

Susan Gwillim , PT

Physical Therapist

NPI 1053410159

Physical Therapist

Dr. Kevin Henry , MD

Anesthesiology - Pain Medicine

NPI 1063490183

Doctor of Medicine (M.D.)

Colleen Cushing Ragon , APN, CNS

Nurse Practitioner - Family

NPI 1073804217

Advanced Practice Nurse, Clinical Nurse Specialist

Anne Waldrop , PT

Physical Therapist

NPI 1114026192

Physical Therapist

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

6 Historical Events

✅

NPI Profile Active August 17, 2012

NPI status registered as active in NPPES database

📍

Updated Practice Location August 17, 2012

Registered at 5401 N KNOXVILLE AVE, SUITE 204, PEORIA, IL 616145098 (Tel: 3096899088)

📍

Updated Business Mailing Address August 17, 2012

Registered at 5401 N KNOXVILLE AVE, SUITE 204, PEORIA, IL 616145098 (Tel: 3096899088)

👤

Provider Name / Credentials Updated August 17, 2012

Recorded as THOMAS KOURI, M.D.

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) August 17, 2012

Internal Medicine (License #036071029 in IL)

🟢

Initial NPI Registration & Enumeration May 10, 2006

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

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NPI Administrative Meta

NPI Number: 1568412773

Entity Type:

Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)

Enumeration Date: May 10, 2006

Last Update: August 17, 2012

Sole Proprietor: Yes

Update or Correct Profile

Mailing Address

5401 N Knoxville Ave, Suite 204

Peoria, IL 616145098

Phone: 3096899088

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).

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