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General NPI Number Information
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NPI Number | 1023108875
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Entity Type | Organization
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Legal Business Name | ILLINOIS ASSOCIATES PSYCHIATRY P C
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 10/06/2025
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Provider Practice Location Address
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Address Line | 103A SOUTH POINTE DRIVE
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City | EDWARDSVILLE
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State | IL
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Zip | 62025-3780
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Country | US
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Telephone | 618-656-2000
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Fax | 618-656-1169
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Provider Business Mailing Address
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Address Line | 103 SOUTHPOINTE DR STE A
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City | EDWARDSVILLE
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State | IL
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Zip | 62025-3780
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Country | US
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Telephone | 618-656-2000
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Fax | 618-656-1169
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Authorized Official
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Title or Position | PROVIDER
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Name | MARK EDWARD FREEMAN
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Credential | MD
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Telephone | 618-656-2000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 060006403
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 060006403
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License Number State | IL
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