Provider Demographics
NPI:1942411491
Name:SHER INSTITUTE FOR REPRODUCTIVE MEDICINE CENTRAL ILLINOIS PC
Entity Type:Organization
Organization Name:SHER INSTITUTE FOR REPRODUCTIVE MEDICINE CENTRAL ILLINOIS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:MILTON
Authorized Official - Middle Name:
Authorized Official - Last Name:MCNICHOL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:309-389-0411
Mailing Address - Street 1:5320 S RAINBOW BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118
Mailing Address - Country:US
Mailing Address - Phone:702-794-0073
Mailing Address - Fax:702-696-0554
Practice Address - Street 1:5401 N KNOXVILLE AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-5098
Practice Address - Country:US
Practice Address - Phone:309-389-0411
Practice Address - Fax:309-689-0784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL25MA05747100207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty