Organization
ILLINOIS EAR, NOSE AND THROAT ASSOCIATES, P.C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFFREY FIERSTEIN M.D. (PRESIDENT)
(618) 451-1800
Entity
Organization
Contact information
Practice address
2120 MADISON AVE, SUITE 200, GRANITE CITY, IL 62040-4744
(618) 451-1800
(618) 451-1526
Mailing address
2120 MADISON AVE, SUITE 200, GRANITE CITY, IL 62040-4744
(618) 451-1800
(618) 451-1526
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
060002662
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CF4039
MEDICARE RAILROAD
—
Enumeration date
02/26/2007
Last updated
07/17/2008
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