Basic Information
| Provider Information | |||||||||
| NPI: | 1932271145 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MCINTEE EAR, NOSE & THROAT, SC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2040 W ILES AVE | ||||||||
| Address2: | SUITE C | ||||||||
| City: | SPRINGFIELD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 627044183 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2177890668 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1132 BROADWAY ST | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | QUINCY | ||||||||
| State: | IL | ||||||||
| PostalCode: | 623012819 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2172244687 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/14/2006 | ||||||||
| LastUpdateDate: | 07/23/2008 | ||||||||
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| AuthorizedOfficialLastName: | MCINTEE | ||||||||
| AuthorizedOfficialFirstName: | RAE | ||||||||
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| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 2172244687 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | 036100190 | IL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Otolaryngology |
No ID Information.