Nulty, William G

Nulty, William G is an individual health care provider with primary practice located at One Illini Dr Medical Service Plan, Peoria IL 61605. He recently has only one registered license in Allopathic & Osteopathic Physicians / Adolescent Medicine, which is considered as his primary health care specialty. Nulty, William G can be contacted via phone (309) 671-8503.

Contact Information

Primary practice address
One Illini Dr Medical Service Plan Peoria IL 61605
Phone: (309) 671-8503
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Adolescent Medicine 2080A0000X 036085410 Illinois

Profile Details

NPI number 1639148356
LBN Legal business name Nulty, William G
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 15th, 2006
Last updated Jul 9th, 2007 - 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 1639148356 NPPES
Illinois Other 07215036 BCBS
Illinois Other IL01DC BCBS
Illinois MEDICAID 036085410 BCBS

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