NPI 1134399421

Dr.Kenbroshddspc

Organisation Point of Service Mascoutah, IL

Practice location

Address: 1180 N 6th St, Mascoutah, IL 62258-1178
Phone: (618) 566-7000
Fax: (618) 566-7000

Authorised official

Name: Ken Neal Brosh
Title: Pres.
Phone: (618) 566-7000

Registered specialties

Point of Service Primary

Managed Care Organizations Taxonomy 305S00000X Licence 019019341 (IL)

Other Point of Service providers in Illinois →

Registry record

NPI: 1134399421
Entity type: Organization
NPI issued: 3 Mar 2008
Record last updated: 3 Mar 2008

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.