WILLIAM G NULTY (NPI# 1639148356) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639148356 |
| Entity Type | Individual |
| Full Name | WILLIAM G NULTY |
| Credential | MD |
| Practice Address |
One Illini Dr Medical Service Plan Peoria IL 61605 |
| Mailing Address |
1 Illini Dr Peoria IL 61605-2576 |
| Practice Telephone | 3096718503 |
| Mailing Telephone | 3096718503 |
| Enumeration Date | 2006-03-15 |
| Last Update Date | 2007-07-09 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2080A0000X |
Pediatrics Specialization: Adolescent Medicine |
036085410 | IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | JOHN DEERE | IL01DC | 01 |
| IL | 036085410 | 05 | |
| IL | BCBS | 07215036 | 01 |
| Street Address |
ONE ILLINI DR MEDICAL SERVICE PLAN |
| City | PEORIA |
| State | IL |
| Zip Code | 61605 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386131878 | Nicholas Anthony Helling | Physical Therapist | 518 W Romero B Garret Ave, Poeria, IL 61605 | 2018-04-19 |
| 1891241022 | Peoria Slf Lp | Assisted Living Facility | 518 West Romeo B. Garrett Avenue, Peoria, IL 61605 | 2016-08-28 |
| 1932479664 | Michelle L Whitelow | Nurse Practitioner | 711 W John Gwynn Jr. Avenue, Peoria, IL 61605 | 2012-01-11 |
| 1982852877 | Jason M Anane-sefah | Orthopaedic Surgery | 303 North Kumpf Boulevard, Peoria, IL 61605 | 2008-09-04 |
| 1902098908 | Calvary Elderly Home Help Program | Home Health | 1709 W Lincoln Ave, Peoria, IL 61605 | 2007-08-14 |
| 1023104437 | Thomas Anderson | Optometrist | 710 W Third Avenue, Peoria, IL 61605 | 2006-10-04 |
| 1841382298 | Devashish Agarwal | Family Medicine | 1701 W. Garden Street, Peoria, IL 61605 | 2006-09-29 |
| 1497763197 | Larry T Rolle | Pharmacist | 411 Martin Luther King Dr., Peoria, IL 61605 | 2006-08-04 |
| 1568404762 | Joseph P Kelly Iv | Physical Therapist | 303 N. Kumpf Blvd, Peoria, IL 61605 | 2006-06-12 |
| 1003861634 | Patrick William Elwood | Neurological Surgery | 719 N William Kumpf Blvd, Suite 100, Peoria, IL 61605 | 2006-05-23 |
| Find all providers in zip 61605 | ||||
| Taxonomy Code | 2080A0000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Adolescent Medicine |
| A pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134198856 | Richard Horndasch | Pediatrics | 1 Illini Dr, Medical Service Plan, Peoria, IL 61605-2576 | 2006-03-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417259979 | Adolescent and Young Adult Place Ltd | Pediatrics | 9 N Cicero Ave, Chicago, IL 60644-3602 | 2010-12-03 |
| 1942520671 | Cherie Priya Dhar | Pediatrics | 1440 N Dayton St Fl 3, Chicago, IL 60642-2644 | 2010-06-04 |
| 1730334764 | Neighborhood Pedicatrics Sc | Pediatrics | 20200 Governors Dr, 101, Olympia Fields, IL 60461-1032 | 2008-11-18 |
| 1790950244 | Kids Place of Willowbrool Sc | Pediatrics | 6727 Kingery Hwy, Willowbrook, IL 60527-5142 | 2008-04-25 |
| 1841475746 | David C. Norman, Md Inc. | Pediatrics | 4600 Memorial Dr Ste G60, Belleville, IL 62226-5366 | 2008-01-09 |
| 1346429859 | Pediatric & Adolescent Center, S.c. | Pediatrics | 125 E Lake Cook Rd Ste 107, Buffalo Grove, IL 60089-4394 | 2007-10-31 |
| 1649475377 | Lisa Kantz Simons | Pediatrics | 225 E Chicago Ave # Ms 161b, Chicago, IL 60611-2991 | 2007-06-21 |
| 1346368487 | Sarah Bush Lincoln Health Center | Pediatrics | 1411 E St, Suite 2, Charleston, IL 61920-2529 | 2007-03-27 |
| 1558402958 | Ashok H Bhaskar | Pediatrics | 2250 Weber Rd, Crest Hill, IL 60435-0928 | 2007-02-09 |
| 1609927417 | Kimberly A Seipel-carrow | Pediatrics | Northwestern University Health Services, 633 Emerson, Evanston, IL 60208-0001 | 2007-01-16 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.