Organization
MID-CENTRAL ILL GASTRO
Active
Other names
Mid-Central ILL Gast LTD
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHEN S MATTER M.D. (PRESIDENT)
(309) 451-1123
Entity
Organization
Contact information
Practice address
2200 JACOBSSEN DR, SUITE B, NORMAL, IL 61761-5516
(309) 451-1123
(309) 451-1212
Mailing address
2200 JACOBSSEN DR, SUITE B, NORMAL, IL 61761-5516
(309) 451-1123
(309) 451-1212
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0360788251
—
IL
05
—
0360818161
—
IL
01
—
05725403
BLUECROSS BLUESHIELD
IL
Enumeration date
02/07/2007
Last updated
08/28/2008
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