Individual
JITENDRA TRIVEDI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4218 LINCOLNSHIRE DR, MOUNT VERNON, IL 62864-2156
(618) 899-3600
(618) 241-4810
Mailing address
4218 LINCOLNSHIRE DR, MOUNT VERNON, IL 62864-2156
(618) 899-3600
(618) 241-4810
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036057566
IL
207RG0100X
Gastroenterology Physician
036057566
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036057566
—
IL
Enumeration date
08/17/2006
Last updated
10/11/2013
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