DR. GEORGE KENNETH SHOTICK JR. (NPI# 1104941657) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104941657 |
| Entity Type | Individual |
| Full Name | DR. GEORGE KENNETH SHOTICK JR. |
| Credential | M.D. |
| Practice Address |
228 Ne Jefferson Ave Peoria IL 61603-3802 |
| Practice Telephone | 3096718000 |
| Practice Fax Number | 3096714695 |
| Mailing Telephone | 3096718000 |
| Mailing Fax Number | 3096714695 |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2016-02-15 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 036-059533 | IL | Allopathic & Osteopathic Physicians |
| Street Address |
228 NE JEFFERSON AVE |
| City | PEORIA |
| State | IL |
| Zip Code | 61603-3802 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326045675 | Christopher Michael Gillette | Pharmacist | 228 Ne Jefferson Ave, Peoria, IL 61603-3639 | 2005-07-01 |
| 1427603935 | Jonathan William Mooney | Nurse Practitioner | 228 Ne Jefferson Ave, Peoria, IL 61603-3802 | 2019-08-02 |
| 1215488697 | Jacqueline Jones Toal | Nurse Practitioner | 228 Ne Jefferson Ave, Peoria, IL 61603-3802 | 2016-10-20 |
| 1588013783 | Krystyn Gunther | Counselor | 228 Ne Jefferson Ave, Peoria, IL 61603-3802 | 2016-06-08 |
| 1578940557 | Human Service Center | Community/Behavioral Health | 228 Ne Jefferson Ave, Peoria, IL 61603-3802 | 2015-04-29 |
| 1679826887 | Cynthia L Gilmer | Counselor | 228 Ne Jefferson Ave, Peoria, IL 61603-3802 | 2012-10-25 |
| 1922351139 | Lyuba Z Shur | Counselor | 228 Ne Jefferson Ave, Peoria, IL 61603-3802 | 2012-10-25 |
| 1922311679 | Human Service Center | Community/Behavioral Health | 228 Ne Jefferson Ave, Peoria, IL 61603-3802 | 2010-07-23 |
| 1679719777 | Suparna Basu | Psychiatry & Neurology | 228 Ne Jefferson Ave, Peoria, IL 61603-3802 | 2008-12-21 |
| 1306880281 | Narayana Reddy | Psychiatry & Neurology | 228 Ne Jefferson Ave, Peoria, IL 61603-3802 | 2006-06-15 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598362980 | Courtney Klein | Nurse Practitioner | 1306 N. Berkley Ave, Peoria, IL 61603 | 2020-10-08 |
| 1114588217 | Kong Xing Wang | Dentist | 320 East Armstrong Ave, Peoria, IL 61603 | 2019-06-28 |
| 1073015319 | Sara Kristine Rosenbery | Nurse Practitioner | 515 Ne Glen Oak Ave Ste 202, Peoria, IL 61603 | 2018-03-02 |
| 1861860058 | Jennifer Michelle Kelsey | Clinical Nurse Specialist | 420 Ne Glen Oak Avenue, Suite 401, Peoria, IL 61603 | 2015-09-04 |
| 1467859793 | Bonnie Lansing | Counselor | 617 N Gendale Avenue, Behavioral Health Adult Program, Peoria, IL 61603 | 2014-12-02 |
| 1639597172 | Jael K. Mahasi | Counselor | 1800 Ne Perry Avenue, Peoria, IL 61603 | 2014-04-02 |
| 1992054829 | Justin S Ferragut | Radiology | 530 Northeast Glen Oak Avenue, Peoria, IL 61603 | 2012-09-06 |
| 1780952994 | Syed Muhammad Tayyab | Internal Medicine | 828 Ne Glen Oak Ave Apt No208a, Peoria, IL 61603 | 2011-12-02 |
| 1528389079 | St. Francis Medical Center | General Acute Care Hospital | 530 N E Glen Oak Ave, Peoria, IL 61603 | 2010-06-18 |
| 1780810648 | Children's Home Association of Illinois | Voluntary or Charitable | 400 E. Frye, Peoria, IL 61603 | 2009-06-05 |
| Find all providers in zip 61603 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
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|---|---|---|---|---|
| 1922621739 | Titan Medical LLC | Family Medicine | 13660 N 94th Dr Ste D-3, Peoria, AZ 85381-4836 | 2020-05-27 |
| 1619516788 | Michelle Martin | Family Medicine | 15182 N 75th Ave # Uint180, Peoria, AZ 85381-4722 | 2020-01-06 |
| 1124667555 | District Medical Group, Inc | Family Medicine | 15182 N 75th Ave Ste 180, Peoria, AZ 85381-4722 | 2020-01-02 |
| 1831693514 | Summa Health Care, PC | Family Medicine | 8877 W Union Hills Dr Ste 240, Peoria, AZ 85382 | 2018-03-19 |
| 1992236848 | Agape Primary Care, Pllc | Family Medicine | 8380 W Emile Zola Ave # 5178, Peoria, AZ 85381-4811 | 2017-03-22 |
| 1043666910 | Honorhealth Medical Group, LLC | Family Medicine | 10230 W Happy Valley Rd, Ste100, Peoria, AZ 85383-2795 | 2016-05-10 |
| 1598160863 | Healthcare Partners Arizona Medical Group LLC | Family Medicine | 16155 N 83rd Ave Ofc, #201, Peoria, AZ 85382-5815 | 2014-10-29 |
| 1164856506 | Charlotte Christie Clayton | Family Medicine | 7505 N Edgewild Dr, Peoria, IL 61614-2117 | 2013-08-21 |
| 1770824112 | Dean Robert Bordeaux | Family Medicine | 7614 N Patton Ln, Peoria, IL 61614-1828 | 2013-03-11 |
| 1467731935 | James Austin Shane Jr. | Family Medicine | 18821 N 94th Ave, Peoria, AZ 85382-3697 | 2011-08-15 |
| Find all providers in PEORIA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.