Healthcare Provider Details

I. General information

NPI: 1104822725
Provider Name (Legal Business Name): ELIZABETH M SWEET-FRIEND M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH M SWEET

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 07/11/2024
Certification Date: 07/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1007 W MAIN ST
FAIRFIELD IL
62837-2308
US

IV. Provider business mailing address

PO BOX 155
CHRISTOPHER IL
62822-0155
US

V. Phone/Fax

Practice location:
  • Phone: 618-842-4470
  • Fax: 618-842-3437
Mailing address:
  • Phone: 618-724-2401
  • Fax: 618-724-4628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036112769
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: