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Organization
SOUTHERN ILLINOIS FAMILY FOOT CARE, LLC
Active
Organization
SOUTHERN ILLINOIS FAMILY FOOT CARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRIAN LEE D.P.M. (PRESIDENT)
(618) 244-3668
Entity
Organization
Contact information
Practice address
221 N 27TH ST, MOUNT VERNON, IL 62864-2941
(618) 244-3668
Mailing address
221 N 27TH ST, MOUNT VERNON, IL 62864-2941
(618) 244-3668
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
016003846
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1285744060
—
IL
Enumeration date
02/17/2013
Last updated
05/16/2014
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