Basic Information
| Provider Information | |||||||||
| NPI: | 1417937574 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CATH | ||||||||
| FirstName: | ANNE | ||||||||
| MiddleName: | MARGARET | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4600 MEMORIAL DR | ||||||||
| Address2: | STE. 440 | ||||||||
| City: | BELLEVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622265368 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6182368000 | ||||||||
| FaxNumber: | 6182368005 | ||||||||
| Practice Location | |||||||||
| Address1: | 4600 MEMORIAL DR | ||||||||
| Address2: | STE. 440 | ||||||||
| City: | BELLEVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622265368 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6182368000 | ||||||||
| FaxNumber: | 6182368005 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2006 | ||||||||
| LastUpdateDate: | 03/20/2014 | ||||||||
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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 | 2010006153 | MO | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 036132144 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.