| Proactive Md Il Sc | |
|
1472 N Green Mount Rd O Fallon IL 62269-3416 | |
| (730) 240-8040 | |
| Not Available |
| Full Name | Proactive Md Il Sc |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 1472 N Green Mount Rd, O Fallon, Illinois |
| Authorized Official Name and Position | Mark Kemble (CMO) |
| Authorized Official Contact | 8645010751 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Proactive Md Il Sc 124 Allawood Ct Simpsonville SC 29681-6207 Ph: (864) 501-0751 | Proactive Md Il Sc 1472 N Green Mount Rd O Fallon IL 62269-3416 Ph: (730) 240-8040 |
| NPI Number | 1881488773 |
|---|---|
| Provider Enumeration Date | 04/07/2025 |
| Last Update Date | 04/07/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881488773 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
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