Organization
MSA ALLIANCE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA K MCDONALD (MANAGER)
(618) 257-4644
Entity
Organization
Contact information
Practice address
4600 MEMORIAL DR STE 260, BELLEVILLE, IL 62226-5363
(618) 257-6302
(618) 257-4838
Mailing address
4500 MEMORIAL DR, BELLEVILLE, IL 62226-5360
(618) 257-4644
(618) 257-6946
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
036144520
IL
Other
Enumeration date
11/15/2017
Last updated
11/15/2017
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