Provider Demographics
NPI:1184875189
Name:ASSOCIATED OTOLARYNGOLOGISTS OF DECATUR
Entity type:Organization
Organization Name:ASSOCIATED OTOLARYNGOLOGISTS OF DECATUR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ENT DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:SOBOL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-876-3372
Mailing Address - Street 1:PO BOX 2170
Mailing Address - Street 2:101W MCKINLEY AVE
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62524-2170
Mailing Address - Country:US
Mailing Address - Phone:217-876-3372
Mailing Address - Fax:217-876-3345
Practice Address - Street 1:101 W MCKINLEY AVE
Practice Address - Street 2:101W MCKINLEY AVE
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-3286
Practice Address - Country:US
Practice Address - Phone:217-876-3372
Practice Address - Fax:217-876-3345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-08
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042006194332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment