Organization
SOUTHERN ILLINOIS GASTROENTEROLOGY LLC
Active
Organization
SOUTHERN ILLINOIS GASTROENTEROLOGY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EDMUNDO A RODRIGUEZ-FRIAS MD (OWNER)
(618) 391-5070
Entity
Organization
Contact information
Practice address
1212 BROADWAY, HIGHLAND, IL 62249-1960
(618) 391-5070
(618) 288-1872
Mailing address
1212 BROADWAY, HIGHLAND, IL 62249-1960
(618) 391-5070
(618) 288-1872
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
—
—
Other
Enumeration date
06/24/2019
Last updated
06/24/2019
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