Graduated: 2018
NPI: 1053004820
Practice Locations (2)
BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY
109 3RD ST
LINCOLN, IL 626562604
2175458000
BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY
303 E BIDWELL ST
TAYLORVILLE, IL 625681363
2175458000
Source: CMS National Downloadable File, September 2026.