Provider Demographics
NPI:1922100742
Name:PLATTNER, PAUL F (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:F
Last Name:PLATTNER
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 1:611 W. PARK ST.
Mailing Address - Street 2:BWPC
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-2500
Mailing Address - Country:US
Mailing Address - Phone:217-383-6792
Mailing Address - Fax:217-383-4752
Practice Address - Street 1:2300 N. VERMILION AVENUE
Practice Address - Street 2:MEDICAL SUB-SPECIALTIES
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832
Practice Address - Country:US
Practice Address - Phone:217-431-7830
Practice Address - Fax:217-431-7756
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036070495207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0533210001OtherDMERC
ILIL3270107Medicare PIN
ILL65312Medicare PIN
A52728Medicare UPIN
IL6447860016Medicare NSC
ILA52728Medicare UPIN