Individual
ALLISON MAGNUSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
405 W JACKSON ST, CARBONDALE, IL 62901-1462
(618) 549-0721
(618) 529-0449
Mailing address
PO BOX 3988, CARBONDALE, IL 62902-3988
(618) 549-0721
(618) 529-0449
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
036150083
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
214881
MEDICARE MULTISPECIALTY GROUP PTAN
IL
Enumeration date
06/02/2015
Last updated
05/12/2021
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