Active NPI
Jan N Upalakalin
- Anatomic Pathology & Clinical Pathology Physician
- Peoria, IL
National Provider Identifier
1700819463
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anatomic Pathology & Clinical Pathology Physician
- Practice address
- 530 NE Glen Oak Ave
Peoria, IL 61637-0001 - Phone
- (309) 624-9011
- NPI assigned
- Jul 8, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anatomic Pathology & Clinical Pathology Physician | 207ZP0102X | IL | Primary |
Addresses
Primary practice location
530 NE Glen Oak Ave
Peoria, IL 61637-0001
Mailing address
10335 N Port Washington Rd
Mequon, WI 53092-5763
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152316800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1193702400000",
"number": "1700819463",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10335 N PORT WASHINGTON RD",
"city": "MEQUON",
"state": "WI",
"postal_code": "530925763"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "530 NE GLEN OAK AVE",
"city": "PEORIA",
"state": "IL",
"postal_code": "616370001",
"telephone_number": "309-624-9011"
}
],
"practiceLocations": [],
"basic": {
"last_name": "UPALAKALIN",
"first_name": "JAN",
"middle_name": "N",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-08",
"last_updated": "2007-10-30",
"status": "A"
},
"taxonomies": [
{
"code": "207ZP0102X",
"taxonomy_group": "",
"desc": "Pathology, Anatomic Pathology & Clinical Pathology",
"state": "IL",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Peoria, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.