Organization · NPI-2

Peoria Ear, Nose And Throat Group, S.C.

Otolaryngology · Peoria, IL

NPI number1952380628
StatusActive
Last updated in NPPESSep 17, 2026

Details

NPI
1952380628
Entity type
Organization (NPI-2)
Legal business name
Peoria Ear, Nose And Throat Group, S.C.
Organization subpart
No
Enumeration date
Jan 11, 2006
Certification date
Sep 17, 2026
Last updated
Sep 17, 2026

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207Y00000X Otolaryngology042000742ILYes
207K00000X Allergy & Immunology––
225100000X Physical Therapist––
231H00000X Audiologist––
237700000X Hearing Instrument Specialist––

Practice location

7301 N Knoxville Ave
Peoria, IL 61614-2017

Phone 309-589-5900 · Fax 309-689-0312

Mailing address

7301 N Knoxville Ave
Peoria, IL 61614-2017

Phone 309-589-5900 · Fax 309-689-0312

Authorized official

Tyler Robertson
Chief Executive Officer
3095898051

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