Maibenco, Douglas Craig
Maibenco, Douglas Craig is an individual health care provider with primary practice located at 1730 E Lake Shore Dr , Decatur IL 62521-3809. He recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as his primary health care specialty. Maibenco, Douglas Craig can be contacted via phone (217) 329-1000.Contact Information
Primary practice address
1730 E Lake Shore Dr
Decatur IL 62521-3809
Phone: (217) 329-1000
Fax: (217) 329-1055
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Surgery | 208600000X | 036098825 | Illinois |
Profile Details
| NPI number | 1366424061 |
|---|---|
| LBN Legal business name | Maibenco, Douglas Craig |
| Credentials | MD PHD |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Nov 17th, 2005 |
| Last updated | Jan 6th, 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 | 1366424061 | NPPES |
| Illinois | MEDICAID | 036098825 | |
| Illinois | Other | CI8411 |
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