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Organization

SOUTHERN ILLINOIS PSYCHIATRY LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
NAEEM A QURESHI (PRESIDENT)
(618) 998-0888
Entity
Organization

Contact information

Practice address
4503 W DEYOUNG ST STE C-103, MARION, IL 62959-0030
(618) 998-0888
(618) 993-1808
Mailing address
4503 W DEYOUNG ST STE C-103, MARION, IL 62959-0030
(618) 998-0888
(618) 993-1808

Taxonomy

Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
036094666
IL
01
207779
MEDICARE
IL
Enumeration date
12/10/2007
Last updated
08/04/2009
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