Basic Information
| Provider Information | |||||||||
| NPI: | 1427204965 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RENAKER-JANSEN | ||||||||
| FirstName: | ELIZABETH | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 340 W LINCOLN ST | ||||||||
| Address2: | SUITE 500 | ||||||||
| City: | BELLEVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622201900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6182777400 | ||||||||
| FaxNumber: | 6182777422 | ||||||||
| Practice Location | |||||||||
| Address1: | 340 W LINCOLN ST | ||||||||
| Address2: | SUITE 500 | ||||||||
| City: | BELLEVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622201900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6182777400 | ||||||||
| FaxNumber: | 6182777422 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2008 | ||||||||
| LastUpdateDate: | 09/22/2016 | ||||||||
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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 | 208600000X | 5101017812 | MI | N | Allopathic & Osteopathic Physicians | Surgery | 208200000X | 036141213 | IL | Y | Allopathic & Osteopathic Physicians | Plastic Surgery |
No ID Information.