Basic Information
| Provider Information | |||||||||
| NPI: | 1740545763 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GADBOIS | ||||||||
| FirstName: | STEPHANIE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2300 N EDWARD ST STE 2139 | ||||||||
| Address2: | |||||||||
| City: | DECATUR | ||||||||
| State: | IL | ||||||||
| PostalCode: | 625264163 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2178762857 | ||||||||
| FaxNumber: | 2178762125 | ||||||||
| Practice Location | |||||||||
| Address1: | 4775 E MARYLAND ST | ||||||||
| Address2: | |||||||||
| City: | DECATUR | ||||||||
| State: | IL | ||||||||
| PostalCode: | 625218802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2178643737 | ||||||||
| FaxNumber: | 2178643468 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2012 | ||||||||
| LastUpdateDate: | 10/05/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 125.061147 | IL | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 036137881 | IL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.