# ADULT INTERNAL MEDICINE PRACTICE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1265688238
- **Authorized official:** DR. CHARLES W AMPADU M.D. (OWNER)
- **Authorized official phone:** (618) 257-0780

## Contact information

- **Practice address:** 15 PARK PL, SWANSEA, IL 62226-2918
- **Practice address phone:** (618) 257-0780
- **Practice address fax:** (618) 257-0715
- **Mailing address:** 15 PARK PL, SWANSEA, IL 62226-2918
- **Mailing address phone:** (618) 257-0780
- **Mailing address fax:** (618) 355-9972

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 08/11/2008
- **Last updated:** 09/06/2021