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Organization
HERRIN PEDIATRICS
Active
Organization
HERRIN PEDIATRICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHAMUNDAMBIKA SHANMUGAM M.D. (OWNER)
(618) 988-6600
Entity
Organization
Contact information
Practice address
121 N 13TH ST, HERRIN, IL 62948-3248
(618) 988-6600
Mailing address
PO BOX 4860, MURRELLS INLET, SC 29576-2698
(843) 651-2624
(843) 357-4940
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
036114856
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036114856
—
IL
Enumeration date
06/02/2008
Last updated
06/12/2008
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