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General NPI Number Information
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NPI Number | 1184750127
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Entity Type | Organization
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Legal Business Name | ILLINOIS EAR, NOSE AND THROAT ASSOCIATES, P.C
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 07/17/2008
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Provider Practice Location Address
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Address Line | 2120 MADISON AVE SUITE 200
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City | GRANITE CITY
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State | IL
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Zip | 62040-4744
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Country | US
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Telephone | 618-451-1800
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Fax | 618-451-1526
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Provider Business Mailing Address
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Address Line | 2120 MADISON AVE SUITE 200
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City | GRANITE CITY
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State | IL
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Zip | 62040-4744
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Country | US
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Telephone | 618-451-1800
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Fax | 618-451-1526
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JEFFREY FIERSTEIN
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Credential | M.D.
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Telephone | 618-451-1800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 060002662
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License Number State | IL
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