Travis Edward Tweedy
Contractor in Carlyle, IL. Individual provider (NPI-1).
NPI number1245102409
StatusActive
Last updated in NPPESSep 18, 2025
Details
- NPI
- 1245102409
- Entity type
- Individual (NPI-1)
- Name
- Travis Edward Tweedy
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Sep 18, 2025
- Certification date
- Sep 18, 2025
- Last updated
- Sep 18, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 171W00000X | Contractor | – | IL | Yes |
Practice location
10700 Old State RdCarlyle, IL 62231-6502
Phone 618-795-0351
Mailing address
10700 Old State RdCarlyle, IL 62231-6502
Phone 618-795-0351
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