Individual
DR. ALFONSO E URDANETA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
705 SOUTH GRAND AVENUE, NASHVILLE, IL 62263-1534
(618) 327-2225
(618) 327-2229
Mailing address
3416 HOTZE ROAD, SALEM, IL 62881-6616
(618) 548-1185
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036047128
IL
208600000X
Surgery Physician
036047128
IL
Other
Enumeration date
05/30/2006
Last updated
11/03/2009
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