Provider Demographics
NPI:1629092226
Name:CONNER-GARCIA, THEMBI A (MD)
Entity Type:Individual
Prefix:
First Name:THEMBI
Middle Name:A
Last Name:CONNER-GARCIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 E ARMSTRONG AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61603-3172
Mailing Address - Country:US
Mailing Address - Phone:309-680-7600
Mailing Address - Fax:309-495-8614
Practice Address - Street 1:1701 W GARDEN ST
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61605
Practice Address - Country:US
Practice Address - Phone:309-680-7600
Practice Address - Fax:309-680-7686
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036107805207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL663598OtherHEALTHLINK
ILP00281868OtherRAILROAD MEDICARE
IL0361078052Medicaid
IL113179OtherHEALTH ALLIANCE
IL7215059OtherBCBS PPO
ILIL01X4OtherJOHN DEERE
IL7215059OtherBCBS PPO
ILH96414Medicare UPIN