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General NPI Number Information
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NPI Number | 1518494996
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Entity Type | Organization
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Legal Business Name | METRO EAST DERMATOLOGY & SKIN CANCER CENTER LLC
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Dates
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Enumeration Date | 05/17/2017
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Last Update Date | 06/28/2022
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Provider Practice Location Address
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Address Line | 331 REGENCY PARK
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City | SHILOH
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State | IL
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Zip | 62269-1887
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Country | US
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Telephone | 618-622-7546
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Fax | 618-227-0098
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Provider Business Mailing Address
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Address Line | 331 REGENCY PARK
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City | O FALLON
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State | IL
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Zip | 62269-1887
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Country | US
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Telephone | 618-622-7546
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Fax | 618-227-0098
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Authorized Official
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Title or Position | OWNER
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Name | DR. JAMIE MCGINNESS
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Credential | MD
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Telephone | 573-268-6330
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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