Organization
SOUTHERN ILLINOIS RESPIRATORY DISEASE CONSULTANTS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SUHAIL ISTANBOULY M.D. (PRESIDENT)
(618) 942-7402
Entity
Organization
Contact information
Practice address
317 S 14TH ST, SUITE 3, HERRIN, IL 62948-3671
(618) 942-7402
Mailing address
317 S 14TH ST, SUITE 3, HERRIN, IL 62948-3671
(618) 942-7402
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
036098950
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036098950
—
IL
Enumeration date
07/16/2008
Last updated
11/04/2008
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