Provider Demographics
NPI:1104845189
Name:DONNA POESCH M.D.S.C
Entity Type:Organization
Organization Name:DONNA POESCH M.D.S.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:POESCH
Authorized Official - Suffix:
Authorized Official - Credentials:MDSC
Authorized Official - Phone:309-277-0772
Mailing Address - Street 1:1302 7TH ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-2900
Mailing Address - Country:US
Mailing Address - Phone:309-277-0772
Mailing Address - Fax:309-277-0774
Practice Address - Street 1:1302 7TH ST
Practice Address - Street 2:SUITE 202
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-2900
Practice Address - Country:US
Practice Address - Phone:309-277-0772
Practice Address - Fax:309-277-0774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA99215OtherWELLMARK BCBS
IL08132063OtherBLUE CROSS OF IL.
IL08132063OtherBLUE CROSS OF IL.
IA99215OtherWELLMARK BCBS