| Mark Fedder, MD, PC | |
|
6810 State Route 162 Suite 211 Maryville IL 62062-8501 | |
| (618) 288-0346 | |
| (618) 288-0349 |
| Full Name | Mark Fedder, MD, PC |
|---|---|
| Speciality | Internal Medicine - Gastroenterology |
| Location | 6810 State Route 162, Maryville, Illinois |
| Authorized Official Name and Position | Mark Stephen Fedder (OWNER/PRESIDENT) |
| Authorized Official Contact | 6182880346 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mark Fedder, MD, PC 6810 State Route 162 Suite 211 Maryville IL 62062-8501 Ph: (618) 288-0346 | Mark Fedder, MD, PC 6810 State Route 162 Suite 211 Maryville IL 62062-8501 Ph: (618) 288-0346 |
| NPI Number | 1184806101 |
|---|---|
| Provider Enumeration Date | 11/30/2007 |
| Last Update Date | 11/30/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184806101 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | (Illinois) | Primary |
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