Provider Demographics
NPI:1588933568
Name:JOSEPH J SOLAN P.C.
Entity type:Organization
Organization Name:JOSEPH J SOLAN P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:SOLAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:217-347-5812
Mailing Address - Street 1:212 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401-3460
Mailing Address - Country:US
Mailing Address - Phone:217-347-5812
Mailing Address - Fax:217-347-5818
Practice Address - Street 1:212 N 4TH ST
Practice Address - Street 2:
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-3460
Practice Address - Country:US
Practice Address - Phone:217-347-5812
Practice Address - Fax:217-347-5818
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOSEPH SOLAN P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-12-21
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038008912261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL200797Medicare UPIN