Individual
DR. SHADI ADEL ALTWAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4500 MEMORIAL DR, BELLEVILLE, IL 62226
(618) 257-6220
(618) 257-6679
Mailing address
4500 MEMORIAL DR, BELLEVILLE, IL 62226-5360
(618) 257-6220
(618) 257-6679
Taxonomy
Speciality
Code
Description
License number
State
208M00000X
Hospitalist Physician
Primary
036-112737
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036112737
—
IL
01
—
08726591
BCBS
IL
01
—
106079
HEALTH ALLIANCE
IL
01
—
717755
HEALTHLINK
IL
Enumeration date
06/20/2006
Last updated
01/29/2021
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