MAIN STREET MEDICAL GROUP LLC is a general practice in O Fallon, IL. The provider is a physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.
Source: National Uniform Claim Committee MAIN STREET MEDICAL GROUP LLC NPI is 1043832769. The provider is registered as an organization entity type and is a multi-specialty group.
The provider's business location address is:
124 REGENCY PARK STE 7
O FALLON, IL
ZIP 62269-994
Phone: (480) 926-2260
The provider's authorized official is Ellie Descalzo .
The authorized official title is Credentialing Officer and has the following contact phone number (480) 926-7800.
The enumeration date for this NPI number is 5/15/2020 and was last updated on 5/4/2021.