Individual
DOMINIQUE C D'SOUZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3 SAINT ELIZABETH BLVD STE 4000, O FALLON, IL 62269-1284
(618) 233-7880
Mailing address
3 SAINT ELIZABETH BLVD, O FALLON, IL 62269-1281
(618) 233-5480
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036.169372
IL
207R00000X
Internal Medicine Physician
036169372
IL
208M00000X
Hospitalist Physician
036169372
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/23/2021
Last updated
08/08/2024
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