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Individual

DR. JOEL KWAN BARRIENTOS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1054 MARTIN LUTHER KING DRIVE, SUITE 121, CENTRALIA, IL 62801-3065
(618) 533-3222
(618) 533-9606
Mailing address
1054 MARTIN LUTHER KING DRIVE, SUITE 121, CENTRALIA, IL 62801-3065
(618) 533-3222
(618) 533-9606

Taxonomy

Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
036069061
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0006100112
BLUE CROSS BLUE SHIELD
IL
05
036069061
IL
Enumeration date
10/24/2006
Last updated
10/12/2011
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