Provider Demographics
NPI:1063520021
Name:QUINONES, JOHN M (DO)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:QUINONES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:PEKIN
Mailing Address - State:IL
Mailing Address - Zip Code:61554-3822
Mailing Address - Country:US
Mailing Address - Phone:309-346-3416
Mailing Address - Fax:309-346-3449
Practice Address - Street 1:1800 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PEKIN
Practice Address - State:IL
Practice Address - Zip Code:61554-3822
Practice Address - Country:US
Practice Address - Phone:309-346-3416
Practice Address - Fax:309-346-3449
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-071254207P00000X
IL036071254207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL02922981OtherBCBS
IL071254OtherOSF HEALTHPLANS
IL014156OtherHEALTH ALLIANCE
IL036071254Medicaid
IL200397OtherBLACK LUNG
IL180740OtherHEALTH LINK
ILIL0103OtherJOHN DEERE
IL0062839OtherUMWA
IL1942315197OtherNPI CLINIC NUMBER
IL020046261Medicare PIN
IL0062839OtherUMWA
IL180740OtherHEALTH LINK
IL545960Medicare ID - Type UnspecifiedMEDICARE GROUP
IL020046261Medicare PIN