# AHS IL MEDICAL GROUP LLC

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

## Provider details

- **NPI number:** 1659098101
- **Authorized official:** JONATHAN E BURKET (COMPLIANCE)
- **Authorized official phone:** (818) 666-0602

## Contact information

- **Practice address:** 2100 MADISON AVE, GRANITE CITY, IL 62040-4713
- **Practice address phone:** (818) 666-0602
- **Mailing address:** 4273 S STATE ROUTE 159, GLEN CARBON, IL 62034-3224
- **Mailing address phone:** (186) 288-2297

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 10/25/2022
- **Last updated:** 10/12/2023