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:
Health care specialties
| Specialty | Code | License # | 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1083613293 | NPPES |
| Illinois | MEDICAID | 016004489 |
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