| NPI | 1548773294 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA K MCDONALD Manager 618-257-4644 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: IL 036144520) |
| Enumeration Date | 2017-11-15 |
| Last Update Date | 2017-11-15 |