Individual
DR. TRUDY M SHADY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4600 MEMORIAL DR STE 200, BELLEVILLE, IL 62226-5363
(618) 233-2220
(618) 233-2555
Mailing address
4500 MEMORIAL DR, BELLEVILLE, IL 62226-5360
(618) 257-4644
(618) 257-6946
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
036-089376
IL
207RP1001X
Pulmonary Disease Physician
Primary
036-089376
IL
207RP1001X
Pulmonary Disease Physician
R3L47
MO
Other
Enumeration date
08/25/2005
Last updated
09/02/2020
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