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General NPI Number Information
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NPI Number | 1013171131
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Entity Type | Organization
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Legal Business Name | OSWALT GENERAL SURGERY, P.C.
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Dates
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Enumeration Date | 07/17/2008
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Last Update Date | 07/18/2011
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Provider Practice Location Address
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Address Line | 942 W ROUTE 6
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City | MORRIS
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State | IL
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Zip | 60450-8858
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Country | US
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Telephone | 815-513-5650
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Fax | 815-513-5652
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Provider Business Mailing Address
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Address Line | 942 W ROUTE 6
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City | MORRIS
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State | IL
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Zip | 60450-8858
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Country | US
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Telephone | 815-513-5650
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Fax | 815-513-5652
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Authorized Official
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Title or Position | M.D.
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Name | DR. KRISTOPHER MICHAEL OSWALT
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Credential | M.D
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Telephone | 815-513-5650
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 036.119946
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License Number State | IL
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