Family Medical Clinic Pllc

NPI #1477019909 in O Fallon, Illinois

Provider Information

NPI Number: 1477019909
Entity Type: Organization
Organization Name: Family Medical Clinic Pllc
Primary Specialty: Internal Medicine
Enumeration Date: Feb 20, 2019
Last Updated: Jul 2, 2020

Practice Location

Address: 1480 N GREEN MOUNT RD SUITE 200
City: O Fallon
State: Illinois
ZIP Code: 62269-3466
Phone: (618) 622-3450

Authorized Official

Name: JACQUELINE MUDD
Title: AUTHORIZED OFFICIAL
Phone: (217) 324-1100

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Family Medicine	207Q00000X
Internal Medicine	207R00000X	Primary

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