Provider Demographics
NPI:1922823913
Name:ACCILIEN ENTERPRISES IL PLLC
Entity type:Organization
Organization Name:ACCILIEN ENTERPRISES IL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YVES-DANY
Authorized Official - Middle Name:
Authorized Official - Last Name:ACCILIEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-924-0236
Mailing Address - Street 1:2203 EASTLAND DR STE 7
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61704-7924
Mailing Address - Country:US
Mailing Address - Phone:309-808-1700
Mailing Address - Fax:
Practice Address - Street 1:2203 EASTLAND DR STE 7
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704-7924
Practice Address - Country:US
Practice Address - Phone:309-808-1700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-15
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty