Organization
OB GYN CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRADLEY J TISSIER MD (MEMBER)
(618) 628-1717
Entity
Organization
Contact information
Practice address
1512 N GREEN MOUNT RD, SUITE 107, O FALLON, IL 62269-1953
(618) 628-1717
(618) 628-1789
Mailing address
1512 N GREEN MOUNT RD, SUITE 107, O FALLON, IL 62269-1953
(618) 628-1717
(618) 628-1789
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
036097979
IL
208600000X
Surgery Physician
036097979
IL
Other
Enumeration date
06/10/2008
Last updated
06/10/2008
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