Organization
REDBIRD PEDIATRICS, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN PONCIROLI MD (PEDIATRICIAN)
(618) 668-2473
Entity
Organization
Contact information
Practice address
793 SUNSET BLVD, O FALLON, IL 62269-1960
(618) 668-2473
Mailing address
793 SUNSET BLVD, O FALLON, IL 62269-1960
(618) 668-2473
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1598776411
—
IL
Enumeration date
09/22/2020
Last updated
03/02/2021
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