DR. PENELOPE A EWBANK MD

Allergy and Immunology

Peoria, Illinois

Provider NPI: 1558358911

Provider Information:
DR. PENELOPE A EWBANK MD


Practice Location:
6615 N BIG HOLLOW RD  PEORIA, IL 61615 US
Tel: 309-691-5200  Fax: --

Business Mailing Address:
  ,   
Tel: --  Fax: --


Taxonomy:

Primary	Code	Category/Description	State	License Number
Y	207K00000X	Physicians Allergy & Immunology	IL	036104932

Other Provider Identifiers:

Issuer	Number	State	Type
	036104932	IL	05

Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin

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