Fairview Heights Medical Group Sc

NPI #1538341094 in Glen Carbon, Illinois

Provider Information

NPI Number: 1538341094
Entity Type: Organization
Organization Name: Fairview Heights Medical Group Sc
Primary Specialty: Urology
Enumeration Date: Nov 27, 2007
Last Updated: Jan 7, 2008

Practice Location

Address: 2246 S STATE ROUTE 157
Address 2: STE. 200
City: Glen Carbon
State: Illinois
ZIP Code: 62034-1717
Phone: (618) 288-5888

Authorized Official

Name: RAYMOND P DAVIDSON II, MD
Title: PRESIDENT
Phone: (314) 286-2028

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Urology	208800000X	Primary

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