Individual
URSULA LOUISE THATCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
6810 STATE ROUTE 162, STE 100, MARYVILLE, IL 62062-8501
(618) 288-0060
(618) 288-0063
Mailing address
6810 STATE ROUTE 162, STE 100, MARYVILLE, IL 62062-8501
(618) 288-0060
(618) 288-0063
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
036-085831
IL
207VG0400X
Gynecology Physician
36980
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0360858311
—
IL
01
—
060-10076
IL BCBS
IL
01
—
1619
MO-BCBS-FACET#
MO
01
—
6010076
IL-BCBS
IL
Enumeration date
01/17/2007
Last updated
12/17/2008
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