Healthcare Provider Details

I. General information

NPI: 1780638932
Provider Name (Legal Business Name): BRIAN L MCELANEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 MEMORIAL DR DEPT RADIOLOGY
BELLEVILLE IL
62226-5360
US

IV. Provider business mailing address

PO BOX 662
EDWARDSVILLE IL
62025-0662
US

V. Phone/Fax

Practice location:
  • Phone: 618-257-9567
  • Fax:
Mailing address:
  • Phone: 877-833-5034
  • Fax: 405-948-6507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: