Healthcare Provider Details

I. General information

NPI: 1033440722
Provider Name (Legal Business Name): ASBERY AND ASSOCIATES OB GYN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2010
Last Update Date: 10/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 CUSUMANO PROFESSIONAL PLAZA DR
MOUNT VERNON IL
62864-6736
US

IV. Provider business mailing address

4227 LINCOLNSHIRE DR
MOUNT VERNON IL
62864-2157
US

V. Phone/Fax

Practice location:
  • Phone: 618-244-4800
  • Fax: 618-241-1746
Mailing address:
  • Phone: 618-242-2317
  • Fax: 618-242-8830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. DAVID ASBERY
Title or Position: MEMBER
Credential: M.D.
Phone: 618-241-1747