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Deactivated NPI 1104975978 Deactivated / Inactive NPI Male Practitioner

Dr. Abraham Fontanilla , MD

Surgery • Watseka, IL

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Dr. Abraham Fontanilla has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date January 09, 2007
NPI Deactivation Date November 10, 2020
Total Practice Duration ~13 Years of Practice (2007 – 2020)

Professional Overview & Biography Verified Profile Summary

Dr. Abraham Fontanilla, MD was a registered Surgery practicing in Watseka, IL. Throughout an active medical career spanning 13 years, Dr. Fontanilla provided care at the practice location at 200 LAIRD LN until profile deactivation on 2020-11-10.

Practice Location & Contact Primary Location

Practice Address

200 Laird Ln

Watseka, IL 609707568

Telephone 8154325411
Fax 8154323955
Associated Practice Facility / Clinic

Specialty Benchmarks & Practice Insights

Comparative analytics for Surgery in Watseka, IL

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 50.0 Yrs
State Avg: 27.3 Yrs
Regional Practice Density
3 Specialists

Practicing in Watseka, IL (1624 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Surgery Primary Specialty

NUCC Taxonomy Code: 208600000X

State License IL 036126637

A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery.

Practice Associates & Co-Workers

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

7 Associated Practitioners
Dr. Angelita Fontanilla , MD

Pediatrics - Neonatal-Perinatal Medicine

NPI 1114076080

Doctor of Medicine (M.D.)

NPI 1144030362

Master of Science in Nursing, Advanced Practice Registered Nurse, Family Nurse Practitioner (Certified)

NPI 1699706101

Doctor of Medicine (M.D.)

NPI 1699833970

Doctor of Medicine (M.D.)

Diana Kaufman , APN

Nurse Practitioner - Family

NPI 1720262652

Advanced Practice Nurse

NPI 1841262086

Doctor of Medicine (M.D.)

Career & Practice History Timeline

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

7 Historical Events
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NPI Profile Deactivated November 10, 2020

Record deactivated on November 10, 2020

NPI Profile Active March 21, 2013

NPI status registered as active in NPPES database

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Updated Practice Location March 21, 2013

Registered at 200 LAIRD LN, WATSEKA, IL 609707568 (Tel: 8154325411)

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Updated Business Mailing Address March 21, 2013

Registered at 200 E FAIRMAN AVE, WATSEKA, IL 609701644 (Tel: 8154325841)

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Provider Name / Credentials Updated March 21, 2013

Recorded as ABRAHAM FONTANILLA, M.D.

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Medical Taxonomy / Specialty Registered (Primary Specialty) March 21, 2013

Surgery (License #036126637 in IL)

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Initial NPI Registration & Enumeration January 09, 2007

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1104975978
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: January 09, 2007
Last Update: March 21, 2013
Deactivation Date: November 10, 2020

Mailing Address

200 E Fairman Ave

Watseka, IL 609701644

Phone: 8154325841

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

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.