Graduated: 1987
NPI: 1275542912
Practice Locations (4)
101 W UNIVERSITY AVE
Champaign, IL 618203909
101 W UNIVERSITY AVE
CHAMPAIGN, IL 618203909
7707 N KNOXVILLE AVE, SUITE 200
PEORIA, IL 616142020
4100 INTERNATIONAL PLZ
FORT WORTH, TX 761094800
Source: CMS National Downloadable File, September 2026.