OrganizationActive
University of Illinois
NPI 1174596225 · Pediatric Neurodevelopmental Disabilities Physician · Peoria, IL
Provider details
- NPI number
- 1174596225
- Entity type
- Organization
- Primary specialty
- Pediatric Neurodevelopmental Disabilities PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- William Nicholas, Executive Director of Msp(312) 413-0573
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Practice location
515 Ne Glen Oak Ave
Pediatric Neurology
Peoria, IL 61603-3165
Phone: (309) 624-9844
Approximate (ZIP-level) locationGet directions
Mailing address
1 Illini Dr
Peoria, IL 61605-2576
Other names (DBA / former)
- Doing business as
- Medical Service Plan at Peoria
Registry dates
- Enumerated
- 2006-02-09
- Last updated
- 2020-08-22
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.