Provider Demographics
NPI:1942270434
Name:SHELLER, DONALD JOE (DPM)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:JOE
Last Name:SHELLER
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 1:3827 N PROSPECT RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61616-7767
Mailing Address - Country:US
Mailing Address - Phone:309-686-1000
Mailing Address - Fax:309-686-8174
Practice Address - Street 1:3827 N PROSPECT RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61616-7767
Practice Address - Country:US
Practice Address - Phone:309-686-1000
Practice Address - Fax:309-686-8174
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016003172213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
4768490001OtherDMERC
IL205059Medicare ID - Type UnspecifiedPRACTICE MEDICARE NUMBER
ILL97271Medicare UPIN