Unknown Individual – Family Medicine Physician, NPI 1053396622
Family Medicine Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for Unknown Individual
3505, Broadway Street, Mount Vernon, Jefferson County, Illinois, 62864, United States
STE A
MOUNT VERNON, IL 628642202
Phone: (618) 244-7788
Fax: (618) 244-9330
Mailing address matches the actual address.
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
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Medicare Enrollment & Revalidation
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No Medicare enrollment or revalidation data available for this provider in our database.
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Medicare Utilization (FFS)
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No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 62864)
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