Basic Information
| Provider Information | |||||||||
| NPI: | 1417908906 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CIHAK | ||||||||
| FirstName: | DEBBIE | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 MEDICAL CENTER DR | ||||||||
| Address2: | |||||||||
| City: | GALENA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 610368118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8157767381 | ||||||||
| FaxNumber: | 8157767385 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 MEDICAL CENTER DR | ||||||||
| Address2: | |||||||||
| City: | GALENA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 610368118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8157767381 | ||||||||
| FaxNumber: | 8157767385 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2006 | ||||||||
| LastUpdateDate: | 10/09/2012 | ||||||||
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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 | 207R00000X | 27986 | IA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 036-081764 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0094946 | 05 | IA | MEDICAID |