Unknown Individual – Surgery Physician, NPI 1891799375
Surgery Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for Unknown Individual
4601, State Street, East Saint Louis, Saint Clair County, Illinois, 62205, United States
EAST SAINT LOUIS, IL 622051359
Phone: (618) 274-4640
Fax: (618) 274-4642
Type: Mailing
129, North 8th Street, East Saint Louis, Saint Clair County, Illinois, 62201, United States
EAST ST LOUIS, IL 622012917
Phone: (618) 482-7242
Fax: (314) 810-1399
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 62205)
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