Organization
ILLINOIS RURAL HEALTHCARE
Active
Organization
ILLINOIS RURAL HEALTHCARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SARFARAZ JASDANWALA MD (CEO)
(031) 295-3563
Entity
Organization
Contact information
Practice address
17781 HORNBEAN DR, WILDWOOD, MO 63005-4229
(312) 953-5636
Mailing address
1003 HAUCK DR, ROLLA, MO 65401-2584
(573) 466-2056
(573) 426-3204
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
207RA0401X
Addiction Medicine (Internal Medicine) Physician
—
—
Other
Enumeration date
07/10/2023
Last updated
07/10/2023
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