Individual
IRENE FEDOROVICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2401 W MAIN ST, MARION, IL 62959-1188
(618) 997-5311
Mailing address
619 LAKE HARBOR DR, MARION, IL 62959-5550
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
2003028760
MO
207W00000X
Ophthalmology Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2003028760
LICENSE
MO
Enumeration date
09/07/2006
Last updated
07/08/2007
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