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General NPI Number Information
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NPI Number | 1265688238
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Entity Type | Organization
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Legal Business Name | ADULT INTERNAL MEDICINE PRACTICE LLC
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Dates
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Enumeration Date | 08/11/2008
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Last Update Date | 09/06/2021
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Provider Practice Location Address
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Address Line | 15 PARK PL
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City | SWANSEA
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State | IL
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Zip | 62226-2918
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Country | US
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Telephone | 618-257-0780
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Fax | 618-257-0715
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Provider Business Mailing Address
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Address Line | 15 PARK PL
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City | SWANSEA
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State | IL
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Zip | 62226-2918
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Country | US
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Telephone | 618-257-0780
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Fax | 618-355-9972
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHARLES W AMPADU
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Credential | M.D.
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Telephone | 618-257-0780
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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