DR. RICHARD D. CORLEY, S.C. (NPI# 1538498209) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1538498209 |
| Entity Type | Organization |
| Organization Name | DR. RICHARD D. CORLEY, S.C. |
| Practice Address |
416 St. Mark Ct. #106 Peoria IL 61603-1928 |
| Practice Telephone | 3096742822 |
| Practice Fax Number | 3096744250 |
| Mailing Telephone | 3096742822 |
| Mailing Fax Number | 3096744250 |
| Enumeration Date | 2009-12-09 |
| Last Update Date | 2009-12-09 |
| Authorized Official Name | RICHARD D. CORLEY (DIRECT OWNER) |
| Authorized Official Telephone | 3096742822 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208200000X | Plastic Surgery | 036-037-295 | IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | 036037295 | 05 |
| Street Address |
416 ST. MARK CT. #106 |
| City | PEORIA |
| State | IL |
| Zip Code | 61603-1928 |
| 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 | 208200000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Plastic Surgery |
| A plastic surgeon deals with the repair, reconstruction or replacement of physical defects of form or function involving the skin, musculoskeletal system, craniomaxillofacial structures, hand, extremities, breast and trunk and external genitalia or cosmetic enhancement of these areas of the body. Cosmetic surgery is an essential component of plastic surgery. The plastic surgeon uses cosmetic surgical principles to both improve overall appearance and to optimize the outcome of reconstructive procedures. The surgeon uses aesthetic surgical principles not only to improve undesirable qualities of normal structures but in all reconstructive procedures as well. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Plastic Surgery, 2007. http://www.abplsurg.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Plastic Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902258874 | Rashid Plastic Surgery, LLC | Plastic Surgery | 804 W Trailcreek Drive, Peoria, IL 61614 | 2016-07-05 |
| 1801914882 | Richard D Corley | Plastic Surgery | 808 W Trailcreek Dr, Peoria, IL 61614-1862 | 2007-03-27 |
| 1780709394 | Jason D Johnson | Plastic Surgery | 15396 N 83rd Ave Ste B100, Peoria, AZ 85381-5626 | 2007-03-20 |
| 1356344626 | Brian B Bruggeman | Plastic Surgery | 14155 N. 83rd Ave, Suite 147, Peoria, AZ 85381 | 2005-05-31 |
| 1538162201 | Martin Lloyd Johnson | Plastic Surgery | 13090 N 94th Dr, Suite 101, Peoria, AZ 85381-4256 | 2005-05-24 |
| 1629416920 | Tyler Andrew Evans | Plastic Surgery | 1001 Main St Ste 300, Peoria, IL 61606-2036 | 2013-06-07 |
| 1154512127 | Kunvarji Gangji Shah | Plastic Surgery | 802 W Trailcreek Dr, Peoria, IL 61614-1862 | 2007-08-06 |
| 1366462475 | Glyn E. Jones | Plastic Surgery | 1001 Main Street, 3rd Floor, Peoria, IL 61606-2037 | 2006-07-20 |
| 1417923517 | John E Lomax | Plastic Surgery | 4909 N Glen Park Place Rd, Peoria, IL 61614-4676 | 2006-02-27 |
| 1356336317 | Michael N Desvigne | Plastic Surgery | 9165 W Thunderbird Rd, Suite 100, Peoria, AZ 85381-4847 | 2005-09-15 |
| 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.