ANTHONY M AVELLINO


Address: 719 N William Kumpf Blvd, Peoria, IL 61605
Phone: 3096760766

ANTHONY M AVELLINO (NPI# 1730279621) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1730279621
Entity Type Individual
Full Name ANTHONY M AVELLINO
Credential MD, MBA
Practice Address 719 N William Kumpf Blvd
Peoria
IL 61605
Mailing Address 804 Service Rd # A109f
East Lansing
MI 48824-7015
Practice Telephone 3096760766
Practice Fax Number 3096765920
Mailing Telephone 5178842976
Mailing Fax Number 5174323928
Enumeration Date 2006-10-13
Last Update Date 2018-05-23
Gender Code M
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 207T00000X Neurological Surgery 4301115254 MI Allopathic & Osteopathic Physicians
N 207T00000X Neurological Surgery MD00033972 WA Allopathic & Osteopathic Physicians

Other Provider Identifier

State Issuer Identifier Type Code
WA 1730279621 05
INTERNAL ID-MOTOR VEHICLE ID 590 01
WA L&I 0252115 01

Provider Secondary Practice Location

Address Telephone Number Fax Number
1200 E Michigan Ave Ste 655, Lansing, MI 489121837 5172672460 5172672462
4660 S Hagadorn Rd Ste 600, East Lansing, MI 488235383 5172672460 5178848602

Office Location

Street Address 719 N WILLIAM KUMPF BLVD
City PEORIA
State IL
Zip Code 61605

Providers in the same location

NPI Name Taxonomy Address Enumeration
1003861634 Patrick William Elwood Neurological Surgery 719 N William Kumpf Blvd, Suite 100, Peoria, IL 61605 2006-05-23
1649820218 Osf Multi-specialty Group Preventive Medicine 719 N William Kumpf Blvd, Peoria, IL 61605-2530 2019-09-16
1285113282 Cole Uebelhor Physical Therapist 719 N William Kumpf Blvd, Peoria, IL 61605-2530 2018-08-09
1871039388 Osf Healthcare System Preventive Medicine 719 N William Kumpf Blvd, Peoria, IL 61605-2530 2017-01-09
1548651490 Julie Deibel Registered Nurse 719 N William Kumpf Blvd, Suite 100, Peoria, IL 61605-2530 2015-02-13
1972933711 April Mcintyre Occupational Therapy Assistant 719 N William Kumpf Blvd, Peoria, IL 61605-2530 2013-11-14
1720326069 Diana L France Clinical Nurse Specialist 719 N William Kumpf Blvd, Peoria, IL 61605-2530 2013-01-22
1194006635 Sarah B Beam Nurse Practitioner 719 N William Kumpf Blvd, Peoria, IL 61605-2525 2011-08-29
1780813758 Saint Francis Medical Center Neurological Surgery 719 N William Kumpf Blvd, Suite 100, Peoria, IL 61605-2530 2009-07-10
1528205069 Illinois Neurological Institute-physicians LLC Durable Medical Equipment & Medical Supplies 719 N William Kumpf Blvd, Suite 100, Peoria, IL 61605-2530 2009-01-20
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1386131878 Nicholas Anthony Helling Physical Therapist 518 W Romero B Garret Ave, Poeria, IL 61605 2018-04-19
1891241022 Peoria Slf Lp Assisted Living Facility 518 West Romeo B. Garrett Avenue, Peoria, IL 61605 2016-08-28
1932479664 Michelle L Whitelow Nurse Practitioner 711 W John Gwynn Jr. Avenue, Peoria, IL 61605 2012-01-11
1982852877 Jason M Anane-sefah Orthopaedic Surgery 303 North Kumpf Boulevard, Peoria, IL 61605 2008-09-04
1902098908 Calvary Elderly Home Help Program Home Health 1709 W Lincoln Ave, Peoria, IL 61605 2007-08-14
1023104437 Thomas Anderson Optometrist 710 W Third Avenue, Peoria, IL 61605 2006-10-04
1841382298 Devashish Agarwal Family Medicine 1701 W. Garden Street, Peoria, IL 61605 2006-09-29
1497763197 Larry T Rolle Pharmacist 411 Martin Luther King Dr., Peoria, IL 61605 2006-08-04
1568404762 Joseph P Kelly Iv Physical Therapist 303 N. Kumpf Blvd, Peoria, IL 61605 2006-06-12
1639148356 William G Nulty Pediatrics One Illini Dr, Medical Service Plan, Peoria, IL 61605 2006-03-15
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Taxonomy Information

Taxonomy Code 207T00000X
Grouping Allopathic & Osteopathic Physicians
Classification Neurological Surgery

Taxonomy Definition

A neurological surgeon provides the operative and non-operative management (i.e., prevention, diagnosis, evaluation, treatment, critical care, and rehabilitation) of disorders of the central, peripheral, and autonomic nervous systems, including their supporting structures and vascular supply; the evaluation and treatment of pathological processes which modify function or activity of the nervous system; and the operative and non-operative management of pain. A neurological surgeon treats patients with disorders of the nervous system; disorders of the brain, meninges, skull, and their blood supply, including the extracranial carotid and vertebral arteries; disorders of the pituitary gland; disorders of the spinal cord, meninges, and vertebral column, including those which may require treatment by spinal fusion or instrumentation; and disorders of the cranial and spinal nerves throughout their distribution.
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added] Additional Resources: American Board of Neurological Surgery, 2007. http://www.abns.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Neurological Surgery.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1003861634 Patrick William Elwood Neurological Surgery 719 N William Kumpf Blvd, Suite 100, Peoria, IL 61605 2006-05-23
1295185056 Thomas Morison Russell Neurological Surgery 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 2016-06-13
1700235280 Nolan Winslow Neurological Surgery 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 2016-06-06
1790167559 Daniel Vollhaber Neurological Surgery 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 2015-06-29
1053793315 Max Kahn Neurological Surgery 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 2015-06-23
1720493000 Sujit Bhimireddy Neurological Surgery 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 2014-06-25
1295173789 Paul Miles Macmahon Neurological Surgery Osf St Francis Medical Ctr, 530 N.e. Glen Oak Ave, Peoria, IL 61637-0001 2013-06-06
1790122141 Kendrick Dewayne Johnson Neurological Surgery Osf St Francis Medical Ctr, 530 N.e. Glen Oak Ave, Peoria, IL 61637-0001 2013-05-24
1326485921 Illinois Neuroscience Institute Neurological Surgery 100 Ne Randolph Ave, Peoria, IL 61606-1919 2013-05-23
1043506942 Derek Martinez Neurological Surgery 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 2011-06-20
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City PEORIA
Zip Code 61605

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Dataset Information

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.

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