Gootee, Michael Joseph

Gootee, Michael Joseph is an individual health care provider with primary practice located at 420 Ne Glen Oak Ave , Peoria IL 61603-3105. He recently has only one registered license in Allopathic & Osteopathic Physicians / Plastic Surgery within the Head & Neck, which is considered as his primary health care specialty. Gootee, Michael Joseph can be contacted via phone (309) 655-4180.

Contact Information

Primary practice address
420 Ne Glen Oak Ave Peoria IL 61603-3105
Phone: (309) 655-4180
Fax: (309) 655-3948
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Plastic Surgery within the Head & Neck 207YX0007X 036090454 Illinois

Profile Details

NPI number 1720050982
LBN Legal business name Gootee, Michael Joseph
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 2nd, 2006
Last updated Mar 20th, 2018 - about 6 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 1720050982 NPPES
Illinois MEDICAID 036090454

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