Provider Demographics
NPI:1790714285
Name:WEST, DAVID S (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:S
Last Name:WEST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 EASTLAND DR
Mailing Address - Street 2:SUITE 320
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61701-3534
Mailing Address - Country:US
Mailing Address - Phone:309-661-2368
Mailing Address - Fax:309-662-9709
Practice Address - Street 1:1505 EASTLAND DR
Practice Address - Street 2:SUITE 320
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-3534
Practice Address - Country:US
Practice Address - Phone:309-661-2368
Practice Address - Fax:309-662-9709
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-092200207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036092200Medicaid
IL2613OtherGROUP #
IL2613064Medicare PIN
IL2613OtherGROUP #
F74148Medicare UPIN
ILP00327715Medicare ID - Type UnspecifiedRR INDIVIDUAL #
ILCA2264Medicare ID - Type UnspecifiedRR GROUP #
ILK29239Medicare ID - Type UnspecifiedINDIVIDUAL #