Unknown Individual – Family Medicine Physician, NPI 1124153804
Family Medicine Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for Unknown Individual
390 MAPLE SUMMIT RD
JERSEYVILLE, IL 620522000
Phone: (618) 498-7518
Fax: (618) 498-3052
Type: Mailing
106 SOUTH WATER ST
HARDIN, IL 620470106
Phone: (618) 576-9407
Fax: (618) 576-2260
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
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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 62052)
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