Provider Demographics
NPI:1659320133
Name:FLETCHER, ESTELLE SHIRLEY (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:ESTELLE
Middle Name:SHIRLEY
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99- 129TH INFANTRY DRIVE
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-5134
Mailing Address - Country:US
Mailing Address - Phone:815-744-3335
Mailing Address - Fax:815-744-3701
Practice Address - Street 1:99- 129TH INFANTRY DRIVE
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-5134
Practice Address - Country:US
Practice Address - Phone:815-744-3335
Practice Address - Fax:815-744-3701
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-089471207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-089471Medicaid
G55581Medicare UPIN