Organization
GABRIELS PRIDE PEDIATRICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS EDMUND LEVVAULH MD (MD PRESIDENT OWNER)
(618) 624-7391
Entity
Organization
Contact information
Practice address
1337 PARK PLAZA DRIVE, SUITE 1, OFALLON, IL 62269-1777
(618) 624-7391
(618) 624-7392
Mailing address
1337 PARK PLAZA DRIVE, SUITE 1, OFALLON, IL 62269-1777
(618) 624-7391
(618) 624-7392
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
036095488
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036095488
—
IL
Enumeration date
05/19/2008
Last updated
05/19/2008
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