Provider Demographics
NPI:1679811590
Name:IWIN (INTEGRATED WORK INJURY NETWORK)
Entity type:Organization
Organization Name:IWIN (INTEGRATED WORK INJURY NETWORK)
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:PETE
Authorized Official - Last Name:DUVENDACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-497-0300
Mailing Address - Street 1:482 WYLIE DR
Mailing Address - Street 2:
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761-5405
Mailing Address - Country:US
Mailing Address - Phone:309-497-0300
Mailing Address - Fax:309-497-1038
Practice Address - Street 1:736 SW WASHINGTON ST STE 2A
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61602-1643
Practice Address - Country:US
Practice Address - Phone:309-497-1014
Practice Address - Fax:309-272-0004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-28
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036082645261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine