Organization
CA GROUP, LLC
Active
Parent organization
CA GROUP, LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
CA GROUP, LLC
Authorized official
LISA K MCDONALD (CREDENTIALING COORDINATOR)
(618) 257-4644
Entity
Organization
Contact information
Practice address
4550 MEMORIAL DR, STE 310, BELLEVILLE, IL 62226-5372
(618) 257-6112
(618) 257-6143
Mailing address
4500 MEMORIAL DR, MEDICAL AFFAIRS CREDENTIALING DEPARTMENT, BELLEVILLE, IL 62226-5360
(618) 257-4644
(618) 257-6946
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
Other
Enumeration date
07/29/2010
Last updated
02/15/2013
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