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SOUTHERN ILLINOIS INTERNAL MEDICINE LTD NPI 1376630103


NPI Information

NPI: 1376630103
Provider Name: SOUTHERN ILLINOIS INTERNAL MEDICINE LTD
Classification: Internal Medicine - 207R00000X
Entity Type: Organization

CLIA Number: 14D0702960

Address:
4600 MEMORIAL DRIVE
SUITE 310
BELLEVILLE, IL
ZIP 62226
Phone: (618) 235-8720
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SOUTHERN ILLINOIS INTERNAL MEDICINE LTD is an internal medicine in Belleville, IL. The provider is a physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. SOUTHERN ILLINOIS INTERNAL MEDICINE LTD NPI is 1376630103. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

4600 MEMORIAL DRIVE
SUITE 310
BELLEVILLE, IL
ZIP 62226-366
Phone: (618) 235-8720
Fax: (618) 235-8725

The provider's authorized official is Mazhar H Lakho .
The authorized official title is Owner Physician and has the following contact phone number (618) 235-8720.

The CLIA number assigned to this NPI record is 14D0702960 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/5/2006 and was last updated on 3/7/2008.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207R00000XInternal MedicineILLINOISYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1205770MEDICARE ID-TYPE UNSPECIFIEDILLINOIS
2E37069MEDICARE UPIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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