Individual
MOMODOU SALLAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2401 W MAIN ST, MARION, IL 62959-1188
(618) 997-5311
Mailing address
1400 DANIELLE CT, MARION, IL 62959-1545
(618) 997-5311
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
085001515
IL
363AM0700X
Medical Physician Assistant
Primary
85001515
IL
Other
Enumeration date
08/31/2006
Last updated
08/03/2009
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