| NPI | 1184806101 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK STEPHEN FEDDER Owner/President 618-288-0346 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: IL 036-067702) |
| Enumeration Date | 2007-11-30 |
| Last Update Date | 2007-11-30 |