Basic Information
| Provider Information | |||||||||
| NPI: | 1023088903 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FOURNIER | ||||||||
| FirstName: | KATHLEEN | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 24007 | ||||||||
| Address2: | |||||||||
| City: | BELLEVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622239007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6182229999 | ||||||||
| FaxNumber: | 6182229337 | ||||||||
| Practice Location | |||||||||
| Address1: | 4600 MEMORIAL DR | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | BELLEVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622265366 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6182229999 | ||||||||
| FaxNumber: | 6182229337 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.