Provider Demographics
NPI:1154327526
Name:ARNOLD, JOHN M (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:ARNOLD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 N COLE ST
Mailing Address - Street 2:
Mailing Address - City:BUSHNELL
Mailing Address - State:IL
Mailing Address - Zip Code:61422-9503
Mailing Address - Country:US
Mailing Address - Phone:309-772-9444
Mailing Address - Fax:
Practice Address - Street 1:1150 N COLE ST
Practice Address - Street 2:
Practice Address - City:BUSHNELL
Practice Address - State:IL
Practice Address - Zip Code:61422-9503
Practice Address - Country:US
Practice Address - Phone:309-772-9444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036062336207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036062336Medicaid
IL014509OtherHEALTH ALLIANCE
IL5515957OtherBLUE CROSS/ BLUE SHIELD
C42743Medicare UPIN
C42743Medicare UPIN
IL036062336Medicaid