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Individual

MR. KENDALL C STACKER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
2745 BROOKMEADOW DR, BELLEVILLE, IL 62221-7116
(618) 257-3090
(618) 257-3090
Mailing address
2745 BROOKMEADOW DR, BELLEVILLE, IL 62221
(618) 257-3090
(618) 257-3090

Taxonomy

Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
IL
343900000X
Non-emergency Medical Transport (VAN)
Primary

Other

Enumeration date
11/21/2013
Last updated
11/21/2013
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