KEITH BURCHILL (NPI# 1508179052) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1508179052 |
| Entity Type | Individual |
| Full Name | KEITH BURCHILL |
| Credential | M.D. |
| Practice Address |
408 Lincoln Dr Ste B Herrin IL 62948-3790 |
| Practice Telephone | 6183514980 |
| Practice Fax Number | 6189938418 |
| Mailing Telephone | 6183514980 |
| Mailing Fax Number | 6189938418 |
| Enumeration Date | 2010-07-26 |
| Last Update Date | 2019-04-17 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 208100000X | Physical Medicine & Rehabilitation | 036-138194 | IL | Allopathic & Osteopathic Physicians |
| Y | 2081P0004X |
Physical Medicine & Rehabilitation Specialization: Spinal Cord Injury Medicine |
036-138194 | IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | 036138194-1 | 05 | |
| IL | RAILROAD MEDICARE | P01538726 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 201 S 14th St, Herrin, IL 629483631 | 6183514950 |
| Street Address |
408 LINCOLN DR STE B |
| City | HERRIN |
| State | IL |
| Zip Code | 62948-3790 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447297676 | Isaac A Roberg | Physician Assistant | 408 Lincoln Dr Ste B, Herrin, IL 62948-3790 | 2006-05-31 |
| 1508476615 | Adam Waller | Nurse Practitioner | 408 Lincoln Dr Ste B, Herrin, IL 62948-3790 | 2020-08-04 |
| 1902371313 | Dietra Leigh Angelly | Nurse Practitioner | 408 Lincoln Dr Ste B, Herrin, IL 62948 | 2018-10-11 |
| 1548270259 | Terrence Glennon | Physical Medicine & Rehabilitation | 408 Lincoln Dr Ste B, Herrin, IL 62948-3790 | 2006-08-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215307590 | Carmelito Miralles Caronongan | Pediatrics | 120 S. 11th St., Herrin, IL 62948 | 2015-09-30 |
| 1073995684 | Motaz R Wraikat | Preventive Medicine | 315 S 13th St Ste 3, Herrin, IL 62948 | 2015-06-19 |
| 1639427933 | Salim Hosein | Surgery | 317 S 14th St Ste 1, Herrin, IL 62948 | 2012-08-17 |
| 1962780288 | Pooja Sareen | Internal Medicine | 3024 S Park Avenue, Herrin, IL 62948 | 2011-08-03 |
| 1235459918 | Timoteo Castro Md & Josefina D. Castro Md Ltd | Family Medicine | 321 South 13st St., Herrin, IL 62948 | 2010-06-04 |
| 1457501926 | Don Cassidy Arnold II | Urology | 220 S Park Ave Fl 2, Herrin, IL 62948 | 2008-09-22 |
| 1306094560 | Karl Keith Mitchener | Speech-Language Pathologist | 1901 N 13th Street, Herrin, IL 62948 | 2008-08-29 |
| 1457509705 | Kathryn Marie Bordenet-jines | Occupational Therapy Assistant | 1901 N. 13th, Herrin, IL 62948 | 2008-08-28 |
| 1417105776 | Cheryl Lynn Matic | Occupational Therapy Assistant | 1901 N. 13th St., Herrin, IL 62948 | 2008-08-28 |
| 1174771422 | Mary Frances Graham | Physical Therapy Assistant | 1901 N. 13th Street, Herrin, IL 62948 | 2008-08-28 |
| Find all providers in zip 62948 | ||||
| Taxonomy Code | 2081P0004X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Physical Medicine & Rehabilitation |
| Specialization | Spinal Cord Injury Medicine |
| A physician who addresses the prevention, diagnosis, treatment and management of traumatic spinal cord injury and non-traumatic etiologies of spinal cord dysfunction by working in an interdisciplinary manner. Care is provided to patients of all ages on a lifelong basis and covers related medical, physical, psychological and vocational disabilities and complications. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition changed, source added] Additional Resources: American Board of Physical Medicine and Rehabilitation, 2007. http://www.abpmr.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Physical Medicine and Rehabilitation. ACGME Accredited Residency Program Requirements: 1 year of training with 3-5 years in relevant specialty for a total of 4-6 years. ABMS Approved Subspecialty Certificate: (Physical Medicine and Rehabilitation) |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366947236 | Advanced Pain & Spine Management, S.c. | Physical Medicine & Rehabilitation | 121 S Wilke Rd Ste 110, Arlington Heights, IL 60005-1524 | 2018-03-24 |
| 1063601847 | Raheemunnisa Rawoof | Physical Medicine & Rehabilitation | 1610 W 63rd St, Southpoint Medical Center, Chicago, IL 60636-2211 | 2007-10-17 |
| 1023238433 | The Board of Trustees of The University of Illinois | Physical Medicine & Rehabilitation | 912 S Wood, Chicago, IL 60612-7327 | 2007-04-26 |
| 1053494864 | Robbie Elizabeth Logan | Physical Medicine & Rehabilitation | Hines Vamc Blg 128, 5th and Roosevelt Rd, Hines, IL 60141 | 2006-10-23 |
| 1083628853 | Yvonne Patrice Lucero | Physical Medicine & Rehabilitation | 5th Avenue At Roosevelt Road, Bldg 128, Hines, IL 60141 | 2006-07-28 |
| 1376996231 | Sushil Singla | Physical Medicine & Rehabilitation | 355 E Erie St Ste 21-2127, Chicago, IL 60611-3167 | 2016-07-15 |
| 1558748269 | Stephanie Deleon Hendrick | Physical Medicine & Rehabilitation | 26w171 Roosevelt Rd, Wheaton, IL 60187-6002 | 2015-05-01 |
| 1699829044 | Marika Lazo Greiff | Physical Medicine & Rehabilitation | 1740 W Taylor St, Chicago, IL 60612-7232 | 2007-01-23 |
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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.