Organization
PERRYVILLE SURGICAL ASSOCIATES SC
Active
Other names
Michael John Beierle MDSC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH W MIHELICH MD (SECRETARY)
(815) 398-0175
Entity
Organization
Contact information
Practice address
535 ROXBURY RD, ROCKFORD, IL 61107-5076
(815) 398-0175
(815) 398-9587
Mailing address
535 ROXBURY RD, ROCKFORD, IL 61107-5076
(815) 398-0175
(815) 398-9587
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0010100629
BLUE CROSS BLUE SHIELD
IL
01
—
L011529
TRICARE
—
Enumeration date
09/15/2006
Last updated
05/18/2011
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