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Contact Information

KEITH L FABRIQUE, MD
1750 E LAKE SHORE DR
LOWER LEVEL
DECATUR, IL62521
 Phone: 217-425-2732
 Fax: 217-425-4778
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Occupational Medicine

2083X0100X 84 Physician/Preventive Medicine
 

Family Medicine

207Q00000X 08 Physician/Family Practice
Indicates primary specialty

NPI Profile & details for KEITH L FABRIQUE · (Male)

NPI # 1225196710
Status Active
Credentials MD
Entity Individual
Enumeration date 12/05/2006
Last updated 12/29/2021 - About 4 years ago
Sole proprietor 1 No
Identifiers
  • IL License # 036050458
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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