Organization
ELBERT A FASNACHT II MD LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELBERT ALVIN FASNACHT II MD (PRESIDENT)
(618) 457-4999
Entity
Organization
Contact information
Practice address
721 SOUTH LEWIS LANE, CARBONDALE, IL 62901-3344
(618) 457-4999
(618) 457-5099
Mailing address
721 SOUTH LEWIS LANE, CARBONDALE, IL 62901-3344
(618) 457-4999
(618) 457-5099
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036075250
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
027366
HEALTH ALLIANCE
IL
05
—
036075250
—
IL
01
—
137121
HEALTHLINK
IL
01
—
DP1138
RAILROAD MEDICARE
IL
Enumeration date
10/16/2006
Last updated
09/10/2009
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