DR. GEORGE KENNETH SHOTICK JR. M.D. NPI 1104941657

Family Medicine in Peoria, IL

About GEORGE SHOTICK

George Shotick is a provider in Peoria, IL with more than 40 years of experience. The NPI number assigned to this provider is 1104941657. The practitioner's primary taxonomy code is Family Medicine (207Q00000X). The provider is registered as an individual and their NPI record was last updated 2 years ago. George Shotick is registered with Medicare but might not accept claims assignment.

NPI1104941657 Additional informationCallout TooltipNational Provider Indentifier (NPI)
The 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.
Provider NameDR. GEORGE KENNETH SHOTICK JR. M.D.
Provider Location Address228 NE JEFFERSON AVE PEORIA, IL 61603 Additional informationCallout TooltipProvider location address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Mailing Address228 NE JEFFERSON AVE PEORIA, IL 61603 Additional informationCallout TooltipProvider mailing address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.
GenderMale
NPI Entity TypeIndividual Additional informationCallout TooltipEntity type code
The code describing the type of health care provider that is being assigned an NPI.
Codes are:
1 = (Person): individual human being who furnishes health care;
2 = (Non-person): entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO).
Medical School NameSOUTHERN ILLINOIS UNIVERSITY SCHOOL OF MEDICINE
Graduation Year1978
Is Sole Proprietor?No
Is Organization Subpart?N/A Additional informationCallout TooltipWhat is a subpart?
Subparts are the components and separate physical locations of organization health care providers. Examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.
Enumeration Date03-20-2007 Additional informationCallout TooltipProvider enumeration date
The date the provider was assigned a unique identifier (assigned an NPI)
Last Update Date02-15-2016 Additional informationCallout TooltipLast update date
The date that a record was last updated or changed.

Business Address

DR. GEORGE KENNETH SHOTICK JR. M.D.
228 NE JEFFERSON AVE
PEORIA, IL
ZIP 61603
Phone: (309) 671-8000
Fax: (309) 671-4695
Get Directions

Mailing Address

DR. GEORGE KENNETH SHOTICK JR. M.D.
228 NE JEFFERSON AVE
PEORIA, IL
ZIP 61603
Phone: (309) 671-8000
Fax: (309) 671-4695

Primary Taxonomy

Taxonomy Code207Q00000X Additional informationCallout TooltipPrimary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
ClassificationFamily Medicine
TypeAllopathic & Osteopathic Physicians
License No.036-059533
License StateIL
Taxonomy DescriptionFamily Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

Additional Identifiers


Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State
C46229MEDICARE UPIN (02)IL

Map Location


DR. GEORGE KENNETH SHOTICK JR. M.D. address is 228 NE JEFFERSON AVE PEORIA, IL 61603

Other Providers at the same location


The following 9 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1215488697 JACQUELINE JONES TOAL
Individual
Nurse Practitioner (Psych/Mental Health)228 NE JEFFERSON AVE
PEORIA, IL 61603
(309) 671-8000
1306880281 NARAYANA REDDY M.D.
Individual
Psychiatry & Neurology (Psychiatry)228 NE JEFFERSON AVE
PEORIA, IL 61603
(309) 671-8000
1326045675DR. CHRISTOPHER MICHAEL GILLETTE PHARM D., BCPP
Individual
Pharmacist (Psychiatric)228 NE JEFFERSON AVE
PEORIA, IL 61603
(309) 671-8000
1396799888HEARTLAND COMMUNITY HEALTH CLINIC
Organization
Clinic/Center (Federally Qualified Health Center (FQHC))228 NE JEFFERSON AVE
PEORIA, IL 61603
(309) 671-8000
1538138318 SHARON T. TEAR NP
Individual
Licensed Practical Nurse228 NE JEFFERSON AVE
PEORIA, IL 61603
(309) 680-7600
1578940557HUMAN SERVICE CENTER
Organization
Community/Behavioral Health228 NE JEFFERSON AVE
PEORIA, IL 61603
(309) 671-8005
1588013783 KRYSTYN GUNTHER LCSW
Individual
Counselor (Addiction (Substance Use Disorder))228 NE JEFFERSON AVE
PEORIA, IL 61603
(309) 671-8005
1679826887 CYNTHIA L GILMER LCSW
Individual
Counselor (Mental Health)228 NE JEFFERSON AVE
PEORIA, IL 61603
(309) 671-8000
1922351139 LYUBA Z SHUR LCPC
Individual
Counselor (Mental Health)228 NE JEFFERSON AVE
PEORIA, IL 61603
(309) 671-8000