Individual
MANISH MATHUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
444 N EDWARDSVILLE ST, STAUNTON, IL 62088-1334
(618) 635-3800
(618) 635-3952
Mailing address
444 N EDWARDSVILLE ST, STAUNTON, IL 62088-1334
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
IL
Other
Enumeration date
10/24/2006
Last updated
07/08/2007
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