Provider Demographics
NPI:1558470690
Name:TOTEL, GREGORY L (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:L
Last Name:TOTEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 MEMORIAL DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-6303
Mailing Address - Country:US
Mailing Address - Phone:217-875-1090
Mailing Address - Fax:217-875-1099
Practice Address - Street 1:1 MEMORIAL DR
Practice Address - Street 2:SUITE 201
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-6303
Practice Address - Country:US
Practice Address - Phone:217-875-1090
Practice Address - Fax:217-875-1099
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036068474207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036068474Medicaid
IL05822058OtherBLUE CROSS BLUE SHIELD
IL05822058OtherBLUE CROSS BLUE SHIELD
ILC46000Medicare UPIN