NPI 1245544543

Phillip A. Immesoete MD, LTD

Organisation Nursing Facility/Intermediate Care Facility Peoria, IL

Practice location

Address: 5401 N Knoxville Ave Suite 406, Peoria, IL 61614-5098
Phone: (309) 691-0030
Fax: (309) 691-9262

Authorised official

Name: Phillip Arthur Immesoete
Title: Physician
Phone: (309) 691-0030

Registered specialties

Nursing Facility/Intermediate Care Facility Primary

Nursing & Custodial Care Facilities Taxonomy 313M00000X Licence 036042568 (IL)

Other Nursing Facility/Intermediate Care Facility providers in Illinois →

Registry record

NPI: 1245544543
Entity type: Organization
NPI issued: 29 Jul 2010
Record last updated: 29 Jul 2010

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.