Deceanne, Anthony V

Deceanne, Anthony V is an individual health care provider with primary practice located at 5017 N Glen Park Place Rd , Peoria IL 61614-4677. He recently has only one registered license in Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery, which is considered as his primary health care specialty. Deceanne, Anthony V can be contacted via phone (309) 691-1589.

Contact Information

Primary practice address
5017 N Glen Park Place Rd Peoria IL 61614-4677
Phone: (309) 691-1589
Fax: (309) 692-2032
Website:
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Health care specialties

SpecialtyCodeLicense #State
Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery 213ES0103X 016004489 Illinois

Profile Details

NPI number 1083613293
LBN Legal business name Deceanne, Anthony V
Credentials Doctor of Podiatric Medicine (DPM)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 19th, 2005
Last updated Mar 29th, 2010 - about 14 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1083613293 NPPES
Illinois MEDICAID 016004489

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