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General NPI Number Information
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NPI Number | 1922203249
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Entity Type | Organization
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Legal Business Name | BRIAN G. MCELHENY, M.D. LTD
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Dates
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Enumeration Date | 06/18/2007
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Last Update Date | 07/16/2013
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Provider Practice Location Address
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Address Line | 207 W JACKSON ST SUITE # 101
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City | CARBONDALE
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State | IL
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Zip | 62901-1408
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Country | US
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Telephone | 618-457-6796
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Fax | 618-549-9799
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Provider Business Mailing Address
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Address Line | 207 W JACKSON ST SUITE # 101
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City | CARBONDALE
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State | IL
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Zip | 62901-1408
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Country | US
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Telephone | 618-457-6796
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Fax | 618-549-9799
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. BRIAN GEORGE MCELHENY, M.D. LTD
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Credential | M.D.
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Telephone | 618-457-6787
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036058838
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License Number State | IL
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