Basic Information
| Provider Information | |||||||||
| NPI: | 1962419614 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EATON | ||||||||
| FirstName: | FRANK | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4227 LINCOLNSHIRE DR | ||||||||
| Address2: | |||||||||
| City: | MOUNT VERNON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 628642157 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6182422317 | ||||||||
| FaxNumber: | 6182429710 | ||||||||
| Practice Location | |||||||||
| Address1: | 503 N MAPLE ST | ||||||||
| Address2: | |||||||||
| City: | EFFINGHAM | ||||||||
| State: | IL | ||||||||
| PostalCode: | 624012006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6182312700 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2006 | ||||||||
| LastUpdateDate: | 11/10/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | 036103229 | IL | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 207L00000X | 036103229 | IL | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 036103299 | 05 | IL | MEDICAID |