Organization
AUSAM CORP CHARTERED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SAMUEL PORIZA AU MD, PHD (PRESIDENT)
(618) 433-7979
Entity
Organization
Contact information
Practice address
6 MEMORIAL DR, ALTON, IL 62002-6751
(618) 433-7979
Mailing address
1 RIVER REACH CT, APT H, ALTON, IL 62002-7387
(618) 967-7275
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
36117470
IL
Other
Enumeration date
04/04/2007
Last updated
10/03/2007
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