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Individual

EDWARD P FEUTZ

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
818 E BROADWAY, SPARTA, IL 62288
(618) 443-2177
(618) 443-3035
Mailing address
1715 DEER TRACKS TRAIL, STE 130, ST LOUIS, MO 63131
(314) 821-5600
(314) 821-2180

Taxonomy

Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
01720700481
IL
01
141008
HEALTHLINK
01
3654662
BLUE CROSS BLUE SHIELD
IL
Enumeration date
04/19/2006
Last updated
07/20/2007
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