Individual
KELLY A. ROURKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
108 GATEWAY COMMERCE CENTER DR N, EDWARDSVILLE, IL 62025-2818
(618) 219-7470
Mailing address
PO BOX 776084, CHICAGO, IL 60677-6084
(618) 219-7470
(618) 219-7469
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
R8N25
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110178092
RAILROAD MEDICARE
MO
Enumeration date
02/27/2006
Last updated
04/29/2024
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