Organization
AHS IL MEDICAL GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JONATHAN E BURKET (COMPLIANCE)
(818) 666-0602
Entity
Organization
Contact information
Practice address
2100 MADISON AVE, GRANITE CITY, IL 62040-4713
(818) 666-0602
Mailing address
4273 S STATE ROUTE 159, GLEN CARBON, IL 62034-3224
(186) 288-2297
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
10/25/2022
Last updated
10/12/2023
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