Individual
DR. M T JOSEPH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD FACC
Contact information
Practice address
3331 W DEYOUNG ST, STE 100, MARION, IL 62959-5896
(618) 998-7600
(618) 997-3630
Mailing address
3331 W DEYOUNG ST, STE 100, MARION, IL 62959-5896
(618) 998-7600
(618) 997-6680
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
036045640
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0010000066
BCBS OF IL
IL
01
—
026849200
FEDERAL BLACK LUNG
—
05
—
036045640
—
IL
01
—
K46805
INDIVIDUAL PTAN
IL
Enumeration date
12/19/2006
Last updated
09/20/2013
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