Provider Demographics
NPI:1891894895
Name:ACORN MEDICAL
Entity Type:Organization
Organization Name:ACORN MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:FLEISCHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:217-854-5099
Mailing Address - Street 1:101 MCCAUSLAND ST
Mailing Address - Street 2:
Mailing Address - City:CARLINVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62626-9133
Mailing Address - Country:US
Mailing Address - Phone:217-854-5099
Mailing Address - Fax:
Practice Address - Street 1:101 MCCAUSLAND ST
Practice Address - Street 2:
Practice Address - City:CARLINVILLE
Practice Address - State:IL
Practice Address - Zip Code:62626-9133
Practice Address - Country:US
Practice Address - Phone:217-854-5099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
148947Medicare ID - Type Unspecified