Healthcare Provider Details

I. General information

NPI: 1609496470
Provider Name (Legal Business Name): ALEXANDRIA MONIQUE MCCLOUD DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2020
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 E SHAWNEE DR STE 3
MURPHYSBORO IL
62966-7072
US

IV. Provider business mailing address

PO BOX 3988
CARBONDALE IL
62902-3988
US

V. Phone/Fax

Practice location:
  • Phone: 618-565-1000
  • Fax: 618-565-1010
Mailing address:
  • Phone: 618-457-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number016006075
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number016006075
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: