Black, Molly Diane
Black, Molly Diane is an individual health care provider with primary practice located at 6000 N Allen Rd , Peoria IL 61614-3294. She recently has only one registered license in Allopathic & Osteopathic Physicians / Orthopaedic Surgery, which is considered as her primary health care specialty. Black, Molly Diane can be contacted via phone (309) 691-1400.Contact Information
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Orthopaedic Surgery | 207X00000X | 036-123359 | Illinois |
Profile Details
| NPI number | 1932214251 |
|---|---|
| LBN Legal business name | Black, Molly Diane |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 19th, 2006 |
| Last updated | Jan 21st, 2022 - about 2 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1932214251 | NPPES |
| Illinois | MEDICAID | 036123359 |
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