Healthcare Provider Details

I. General information

NPI: 1902649163
Provider Name (Legal Business Name): JESSICA LIN DRAUS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2024
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 MEMORIAL DR MEDICAL OFFICE BLDG, A, SUITE 220
ALTON IL
62002-6705
US

IV. Provider business mailing address

2 MEMORIAL DR MEDICAL OFFICE BLDG, A, SUITE 220
ALTON IL
62002-6705
US

V. Phone/Fax

Practice location:
  • Phone: 618-474-1723
  • Fax: 618-433-6299
Mailing address:
  • Phone: 618-474-1723
  • Fax: 618-433-6299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number125.084065
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: