Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of October 4, 2026.

Peoria Ear, Nose and Throat Group, SC

Organization Allergy & Immunology Physician · NPI 1952380628

Peoria Ear, Nose and Throat Group, SC provides Allergy & Immunology Physician services in Peoria, Illinois. Licensed in Illinois. Registered with an NPI since 2006.

Licensed in
IL
In the registry since
2006
Specialties on file
5

Practice location Address checks out

7301 N Knoxville Ave
Peoria, IL 61614-2017
Phone: (309) 589-5900
Fax: (309) 689-0312
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Otolaryngology Physician (primary) Taxonomy 207Y00000X · Licence 042000742 (IL)
Allergy & Immunology Physician Taxonomy 207K00000X
Physical Therapist Taxonomy 225100000X
Audiologist Taxonomy 231H00000X
Hearing Instrument Specialist Taxonomy 237700000X

Record details

NPI number1952380628
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Tyler Robertson — Chief Executive Officer · (309) 589-8051
NPI enumeratedJanuary 11, 2006
Last updated in NPPESSeptember 17, 2026
Certification dateSeptember 17, 2026
Mailing address7301 N Knoxville Ave, Peoria, IL 61614-2017

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