Individual
MICHAEL W ELLIOTT II
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
807 W. CRAFT ST., ROBINSON, IL 62454-1137
(618) 546-5052
(618) 544-2094
Mailing address
807 W. CRAFT ST., ROBINSON, IL 62454-1137
(618) 546-5052
(618) 544-2094
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
036102103
IL
261QR1300X
Rural Health Clinic/Center
Primary
036-102103
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036102103
—
IL
Enumeration date
07/05/2005
Last updated
10/03/2013
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