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Organization

CHRISTINA L MIDKIFF MD SC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
CHRISTINA L MIDKIFF M.D. (PRESIDENT)
(618) 288-7408
Entity
Organization

Contact information

Practice address
2023 VADALABENE DR, SUITE 200, MARYVILLE, IL 62062-5630
(618) 288-7408
(618) 288-7418
Mailing address
2023 VADALABENE DR, SUITE 200, MARYVILLE, IL 62062-5630
(618) 288-7408
(618) 288-7418

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
036097885
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
036097885
IL
01
214530
MEDICARE GROUP NUMBER
IL
01
DF8821
MEDICARE RAILROAD
IL
01
K33873
MEDICARE PROVIDER NUMBER
IL
Enumeration date
11/20/2006
Last updated
10/15/2024
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