Provider Demographics
NPI:1144233495
Name:BIRKHOLZ, JILL A (MD)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:A
Last Name:BIRKHOLZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7620 N UNIVERSITY ST
Mailing Address - Street 2:SUITE 108
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-1297
Mailing Address - Country:US
Mailing Address - Phone:309-692-5600
Mailing Address - Fax:309-692-5601
Practice Address - Street 1:7620 N UNIVERSITY ST
Practice Address - Street 2:SUITE 108
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-1297
Practice Address - Country:US
Practice Address - Phone:309-692-5600
Practice Address - Fax:309-692-5601
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL208303Medicare ID - Type UnspecifiedMEDICARE
ILH04184Medicare UPIN