Basic Information
| Provider Information | |||||||||
| NPI: | 1962818823 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCNEESE | ||||||||
| FirstName: | SAFIYA | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4 MEMORIAL DR STE 210 | ||||||||
| Address2: | |||||||||
| City: | ALTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 620026704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6184635905 | ||||||||
| FaxNumber: | 6184635935 | ||||||||
| Practice Location | |||||||||
| Address1: | 4 MEMORIAL DR STE 210 | ||||||||
| Address2: | |||||||||
| City: | ALTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 620026704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6184635905 | ||||||||
| FaxNumber: | 6184635935 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2014 | ||||||||
| LastUpdateDate: | 02/02/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 036156441 | IL | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 01079469A | IN | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 125.064624 | IL | N | Allopathic & Osteopathic Physicians | Family Medicine | 208M00000X | 036156441 | IL | N | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.