Individual
GREGORY THOMAS BISMACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
503 N MAPLE ST, EFFINGHAM, IL 62401-2006
(217) 342-2121
Mailing address
801 SWARTHMORE LN, UNIVERSITY CITY, MO 63130-3620
(248) 808-2485
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036.155470
IL
207R00000X
Internal Medicine Physician
4301097035
MI
Other
Enumeration date
04/08/2010
Last updated
12/05/2022
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