Physical Medicine Clinic of Granite City Ltd
NPI #1083986541 in Granite City, Illinois
Provider Information
- NPI Number
- 1083986541
- Entity Type
- Organization
- Organization Name
- Physical Medicine Clinic of Granite City Ltd
- Subpart
- Yes (part of a larger organization)
- Parent Organization
- PHYSICAL MEDICINE CLINIC OF GRANITE CITY LTD
- Primary Specialty
- Non-Pharmacy Dispensing Site
- Enumeration Date
- Jan 31, 2012
- Last Updated
- Jan 31, 2012
Practice Location
- Address
- 2861 MADISON AVE
- City
- Granite City
- State
- Illinois
- ZIP Code
- 62040-3614
- Phone
- (618) 877-4000
Authorized Official
- Name
- DR. BUD CHOMBIRUN, M.D.
- Title
- MEDICAL DIRECTOR
- Phone
- (618) 877-4000
Specialties & Taxonomy Codes
| Specialty |
|---|
| Non-Pharmacy Dispensing Site |
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