# ELBERT A FASNACHT II MD LTD

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

## Provider details

- **NPI number:** 1962582700
- **Authorized official:** ELBERT ALVIN FASNACHT II MD (PRESIDENT)
- **Authorized official phone:** (618) 457-4999

## Contact information

- **Practice address:** 721 SOUTH LEWIS LANE, CARBONDALE, IL 62901-3344
- **Practice address phone:** (618) 457-4999
- **Practice address fax:** (618) 457-5099
- **Mailing address:** 721 SOUTH LEWIS LANE, CARBONDALE, IL 62901-3344
- **Mailing address phone:** (618) 457-4999
- **Mailing address fax:** (618) 457-5099

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | 036075250 | IL | Yes |

## Other

- **Enumeration date:** 10/16/2006
- **Last updated:** 09/10/2009