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Individual

DR. MESHACH VEDANAYAGAM SAMUEL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
2401 W MAIN ST, MARION, IL 62959-1188
(618) 997-5311
Mailing address
14614 GOSSETT RD, WEST FRANKFORT, IL 62896-4219
(618) 937-6650

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036-103980
IL

Other

Enumeration date
02/14/2006
Last updated
12/01/2016
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