Provider Demographics
NPI:1467520700
Name:DAVID M OLIGSCHLAEGER DO LLC
Entity Type:Organization
Organization Name:DAVID M OLIGSCHLAEGER DO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:OLIGSCHLAEGER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:217-774-7883
Mailing Address - Street 1:207 S PINE ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:SHELBYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62565-1749
Mailing Address - Country:US
Mailing Address - Phone:217-774-7883
Mailing Address - Fax:217-774-5935
Practice Address - Street 1:207 S PINE ST
Practice Address - Street 2:SUITE F
Practice Address - City:SHELBYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62565-1749
Practice Address - Country:US
Practice Address - Phone:217-774-7883
Practice Address - Fax:217-774-5935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036099152207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036099152Medicaid
IL210984Medicare PIN