Dr Mark Stanley Wasserman, MD | |
2100 Madison Ave, Granite City, IL 62040-4701 | |
(618) 451-4872 | |
(618) 451-6203 |
Full Name | Dr Mark Stanley Wasserman |
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Gender | Male |
Speciality | Obstetrics & Gynecology |
Location | 2100 Madison Ave, Granite City, Illinois |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1225130933 | NPI | - | NPPES |
036104995 | Medicaid | IL |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207V00000X | Obstetrics & Gynecology | 036104995 (Illinois) | Primary |
207V00000X | Obstetrics & Gynecology | R2F91 (Missouri) | Secondary |
Entity Name | Osf Multi-specialty Group |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1922445527 PECOS PAC ID: 3678889789 Enrollment ID: O20150904000279 |
Mailing Address | Practice Location Address |
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Dr Mark Stanley Wasserman, MD 2100 Madison Ave, Granite City, IL 62040-4701 Ph: (618) 451-4872 | Dr Mark Stanley Wasserman, MD 2100 Madison Ave, Granite City, IL 62040-4701 Ph: (618) 451-4872 |
Dr. Srilakshmi Vuyyuru, M.D., Obstetrics & Gynecology Medicare: Accepting Medicare Assignments Practice Location: 2166 Madison Ave, Granite City, IL 62040 Phone: 618-451-4872 Fax: 618-451-6203 | |
Dr. Melvin D Merritt, M.D. Obstetrics & Gynecology Medicare: Accepting Medicare Assignments Practice Location: 2166 Madison Ave, Granite City, IL 62040 Phone: 618-451-4872 Fax: 618-451-6203 | |
Erin Lee King, M.D. Obstetrics & Gynecology Medicare: Accepting Medicare Assignments Practice Location: 1602 21st St, Granite City, IL 62040 Phone: 618-451-5722 Fax: 618-451-9092 |