Provider Demographics
NPI:1689616815
Name:FLEISCHLI, JOHN G (DPM)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:G
Last Name:FLEISCHLI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1745 W WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62650-6126
Mailing Address - Country:US
Mailing Address - Phone:800-532-6279
Mailing Address - Fax:
Practice Address - Street 1:2901 OLD JACKSONVILLE RD STE C
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-7437
Practice Address - Country:US
Practice Address - Phone:217-546-5949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016004737213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL326594/270056166OtherHEALTHLINK PPO
IL06932011OtherBCBS OF ILLINOIS
IL016004737/4974780001OtherMEDICARE DMERC
ILHEALTH ALLIANCEOther030583
ILP00027607/DA1788OtherRAILROAD MEDICARE
IL016004737Medicaid
ILHEALTH ALLIANCEOther030583
IL016004737/4974780001OtherMEDICARE DMERC