Provider Demographics
NPI:1740454214
Name:APICHART L RADEE MD SC
Entity type:Organization
Organization Name:APICHART L RADEE MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:APICHART
Authorized Official - Middle Name:L
Authorized Official - Last Name:RADEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:309-637-0177
Mailing Address - Street 1:900 MAIN ST
Mailing Address - Street 2:SUITE 710
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61602-1005
Mailing Address - Country:US
Mailing Address - Phone:309-637-0177
Mailing Address - Fax:309-637-0736
Practice Address - Street 1:900 MAIN ST
Practice Address - Street 2:SUITE 710
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61602-1005
Practice Address - Country:US
Practice Address - Phone:309-637-0177
Practice Address - Fax:309-637-0736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-057355207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty