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General NPI Number Information
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NPI Number | 1427331891
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Entity Type | Organization
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Legal Business Name | STEPHEN T ANG MD SC
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Dates
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Enumeration Date | 09/22/2011
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Last Update Date | 10/27/2011
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Provider Practice Location Address
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Address Line | 1054 MARTIN LUTHER KING DR STE 120
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City | CENTRALIA
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State | IL
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Zip | 62801-3000
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Country | US
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Telephone | 618-532-1688
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Fax | 618-436-8081
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Provider Business Mailing Address
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Address Line | 1054 MARTIN LUTHER KING DR STE 120
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City | CENTRALIA
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State | IL
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Zip | 62801-3000
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Country | US
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Telephone | 618-532-1688
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Fax | 618-436-8081
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Authorized Official
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Title or Position | PHYSICIAN
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Name | STEPHEN ANG
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Credential | MD
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Telephone | 618-532-1688
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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