Individual
IMANI ANWISYE-MASHELE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1818 E WINDSOR RD, URBANA, IL 61802-9566
(217) 255-9670
(217) 255-9724
Mailing address
611 W. PARK ST., BWPC, URBANA, IL 61801-2500
(217) 383-6792
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036139294
IL
207Q00000X
Family Medicine Physician
2012020598
MO
Other
Enumeration date
06/26/2012
Last updated
02/04/2016
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