Dick, Herman Justis

Dick, Herman Justis is an individual health care provider with primary practice located at 2204 Eastland Dr , Bloomington IL 61704-3566. He recently has only one registered license in Other Service Providers / Specialist, which is considered as his primary health care specialty. Dick, Herman Justis can be contacted via phone (309) 662-9461.

Contact Information

Primary practice address
2204 Eastland Dr Bloomington IL 61704-3566
Phone: (309) 662-9461
Fax: (309) 663-0222
Website:
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Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X 036056374 Illinois

Profile Details

NPI number 1891891370
LBN Legal business name Dick, Herman Justis
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 15th, 2006
Last updated May 21st, 2008 - about 18 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 1891891370 NPPES
Illinois Other 5715381 BLUE CROSS BLUE SHIELD
Illinois Other 130005238 BLUE CROSS BLUE SHIELD
Illinois MEDICAID 036056374 BLUE CROSS BLUE SHIELD

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