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Individual

DR. KETAN C VYAS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
610 N COURT ST, GRAYVILLE, IL 62844
(618) 375-7101
(618) 375-7183
Mailing address
610 N COURT ST, GRAYVILLE, IL 62844
(618) 375-7101
(618) 375-7183

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
01043808A
IN
207R00000X
Internal Medicine Physician
Primary
036091476
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0009707064
BLUE CROSS
IL
05
036091476
IL
01
110136426
RAILROAD MEDICARE
01
282819
HEALTHLINK
Enumeration date
02/28/2006
Last updated
04/22/2010
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