Provider Demographics
NPI:1205864170
Name:ESTES, NORMAN C (MD)
Entity type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:C
Last Name:ESTES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1001 MAIN STREET
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61606
Mailing Address - Country:US
Mailing Address - Phone:309-495-0200
Mailing Address - Fax:309-676-6545
Practice Address - Street 1:1001 MAIN STREET
Practice Address - Street 2:SUITE 300
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61606
Practice Address - Country:US
Practice Address - Phone:309-495-0200
Practice Address - Fax:309-676-6545
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036098397208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL7215166OtherBCBS
IL036098397Medicaid
IL036098397-02Medicaid
IL036098397-02Medicaid