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Organization

SOUTHERN ILLINOIS FAMILY FOOT CARE, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. BRIAN LEE D.P.M. (PRESIDENT)
(618) 244-3668
Entity
Organization

Contact information

Practice address
221 N 27TH ST, MOUNT VERNON, IL 62864-2941
(618) 244-3668
Mailing address
221 N 27TH ST, MOUNT VERNON, IL 62864-2941
(618) 244-3668

Taxonomy

Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
016003846
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1285744060
IL
Enumeration date
02/17/2013
Last updated
05/16/2014
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