Individual
ELLIE MARIE BENTLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
220 S PARK AVE FL 3, HERRIN, IL 62948
(618) 942-2002
(618) 351-6497
Mailing address
PO BOX 3988, CARBONDALE, IL 62902-3988
(618) 457-5200
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
036150570
IL
Other
Enumeration date
07/28/2013
Last updated
09/13/2021
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