Organization
ST ANTHONY'S PHYSICIAN ORGANIZATION OF ILLINOIS
Active
Other names
St Anthony's at Waterloo OB/GYN Specialists
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH VENUTO (CHIEF FINANCIAL OFFICER)
(314) 525-7340
Entity
Organization
Contact information
Practice address
509 HAMACHER ST, STE 203, WATERLOO, IL 62298-1592
(618) 939-0575
(618) 939-0577
Mailing address
509 HAMACHER ST, STE 203, WATERLOO, IL 62298-1592
(618) 939-0575
(618) 939-0577
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
Other
Enumeration date
02/05/2015
Last updated
02/05/2015
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