Organization
MAPLE STREET CLINIC LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LINDA E HUNGERFORD MD (PRESIDENT)
(618) 839-1561
Entity
Organization
Contact information
Practice address
1401 15TH ST, LAWRENCEVILLE, IL 62439-2223
(618) 839-4618
(618) 943-1700
Mailing address
1401 15TH ST, LAWRENCEVILLE, IL 62439-2223
(618) 839-4618
(618) 943-1700
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
036072942
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036072942
—
IL
Enumeration date
07/25/2006
Last updated
03/19/2014
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