| Elbert A Fasnacht Ii Md Ltd | |
|
721 South Lewis Lane Carbondale IL 62901-3344 | |
| (618) 457-4999 | |
| (618) 457-5099 |
| Full Name | Elbert A Fasnacht Ii Md Ltd |
|---|---|
| Speciality | Internal Medicine |
| Location | 721 South Lewis Lane, Carbondale, Illinois |
| Authorized Official Name and Position | Elbert Alvin Fasnacht (PRESIDENT) |
| Authorized Official Contact | 6184574999 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Elbert A Fasnacht Ii Md Ltd 721 South Lewis Lane Carbondale IL 62901-3344 Ph: (618) 457-4999 | Elbert A Fasnacht Ii Md Ltd 721 South Lewis Lane Carbondale IL 62901-3344 Ph: (618) 457-4999 |
| NPI Number | 1962582700 |
|---|---|
| Provider Enumeration Date | 10/16/2006 |
| Last Update Date | 09/10/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962582700 | NPI | - | NPPES |
| 036075250 | Medicaid | IL | |
| DP1138 | Other | IL | RAILROAD MEDICARE |
| 027366 | Other | IL | HEALTH ALLIANCE |
| 137121 | Other | IL | HEALTHLINK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 036075250 (Illinois) | Primary |
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