Organization
AEF MANAGEMENT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANE R FANCHER (OWNER)
(847) 615-2200
Entity
Organization
Contact information
Practice address
1600 W WALNUT ST, JACKSONVILLE, IL 62650-1136
(217) 245-9541
(217) 479-8781
Mailing address
PO BOX 570, LAKE FOREST, IL 60045-0570
(847) 615-2200
(888) 735-8731
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
036094339
IL
Other
Enumeration date
06/04/2014
Last updated
08/22/2014
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