Provider Demographics
NPI:1265726327
Name:BOCKER, EMILEE JO (MD)
Entity type:Individual
Prefix:
First Name:EMILEE
Middle Name:JO
Last Name:BOCKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 E JOE DR
Mailing Address - Street 2:
Mailing Address - City:AMBOY
Mailing Address - State:IL
Mailing Address - Zip Code:61310
Mailing Address - Country:US
Mailing Address - Phone:815-857-3044
Mailing Address - Fax:815-857-2010
Practice Address - Street 1:305 E JOE DR
Practice Address - Street 2:
Practice Address - City:AMBOY
Practice Address - State:IL
Practice Address - Zip Code:61310
Practice Address - Country:US
Practice Address - Phone:815-857-3044
Practice Address - Fax:815-857-2010
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-07
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.134064207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036134064Medicaid
ILF400168653OtherMEDICARE-KATHERINE SHAW BETHEA HOSPITAL
ILF400148570OtherMEDICARE-KSB MED GROUP