Individual
JAN AXELBAUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
211 S 3RD ST, BELLEVILLE, IL 62220-1915
(618) 234-2120
(618) 641-5806
Mailing address
211 S 3RD ST, BELLEVILLE, IL 62220-1915
(618) 234-2120
(618) 641-5806
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
2002001971
MO
208M00000X
Hospitalist Physician
Primary
036138448
IL
208M00000X
Hospitalist Physician
2002001971
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1356581730
—
MO
Enumeration date
02/25/2009
Last updated
06/30/2015
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