Provider Demographics
NPI:1497715056
Name:OPILKA, JOHN P (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:P
Last Name:OPILKA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1005 HEALTH CENTER DR STE 201
Mailing Address - Street 2:
Mailing Address - City:MATTOON
Mailing Address - State:IL
Mailing Address - Zip Code:61938-4653
Mailing Address - Country:US
Mailing Address - Phone:217-342-3400
Mailing Address - Fax:217-258-2216
Practice Address - Street 1:5 E CUMBERLAND RD
Practice Address - Street 2:
Practice Address - City:ALTAMONT
Practice Address - State:IL
Practice Address - Zip Code:62411-1271
Practice Address - Country:US
Practice Address - Phone:618-483-6151
Practice Address - Fax:618-483-6153
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036099320207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL080191496OtherRAILROAD MEDICARE
IL170988OtherPERSONAL CARE
1735285OtherFIRST HEALTH/ COVENTRY
IL412343OtherHEALTHLINK
IL0032540022OtherBLUE CROSS BLUE SHIELD IL
IL055846OtherHEALTH ALLIANCE
IL371391171001Medicaid
IL412343OtherHEALTHLINK
561920Medicare ID - Type UnspecifiedMEDICARE GROUP #
O80191496Medicare ID - Type UnspecifiedRAILROAD MEDICARE
L94693Medicare PIN
IL080191496OtherRAILROAD MEDICARE
BO6215900OtherDEA #