| NPI | 1508953746 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REBECCA J TIBEREND Billing Officer Supervisor 618-222-9999 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine Gastroenterology |
| Additional Taxonomies | 207VG0400X Obstetrics & Gynecology Gynecology |
| 2084P0800X Psychiatry & Neurology Psychiatry | |
| 208800000X Urology | |
| Enumeration Date | 2006-10-09 |
| Last Update Date | 2018-06-21 |