Basic Information
| Provider Information | |||||||||
| NPI: | 1235389727 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TATE | ||||||||
| FirstName: | LINDSAY | ||||||||
| MiddleName: | BRIANN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 347 SCHULZKI LN | ||||||||
| Address2: | |||||||||
| City: | EAST PEORIA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 616119487 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8642939915 | ||||||||
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| Practice Location | |||||||||
| Address1: | 19 OLT AVE | ||||||||
| Address2: | |||||||||
| City: | PEKIN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 615546214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3093536301 | ||||||||
| FaxNumber: | 4076483686 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2008 | ||||||||
| LastUpdateDate: | 07/27/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 036133748 | IL | Y | Allopathic & Osteopathic Physicians | Family Medicine | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.