Unknown Individual – Obstetrics & Gynecology Physician, NPI 1114093986
Obstetrics & Gynecology Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for Unknown Individual
Park Drive, Garden Village, Fairmont, Marion County, West Virginia, 26554, United States
MARION, IL 629596477
Phone: (618) 997-5266
Fax: (618) 997-5285
Type: Mailing
1407, McPherson Avenue, Mount Vernon, Jefferson County, Illinois, 62864, United States
MOUNT VERNON, IL 628642822
Phone: (618) 997-5266
Fax: (618) 899-9010
Type: Location
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
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
No Medicare enrollment or revalidation data available for this provider in our database.
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Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
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No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 62959)
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