| NPI | 1598777435 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VEENA K GUPTA CEO 618-244-7200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207QG0300X Family Medicine Geriatric Medicine |
| 207QS0010X Family Medicine Sports Medicine | |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2008-08-29 |