MEDICARE: SALEM FAMILY PRACTICE, SC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician		IL

General Provider Information

NPI Number	:	1700065851
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SALEM FAMILY PRACTICE, SC

Provider Business Mailing Address
First Line	:	1325 W WHITTAKER ST
Second Line	:	SUITE #3
City	:	SALEM
State	:	IL
Zip	:	62881-2007
Country	:	US
Telephone Number	:	618-740-0341
Fax Number	:	618-740-0343

Provider Business Practice Location Address
First Line	:	1325 W WHITTAKER ST
Second Line	:	SUITE #3
City	:	SALEM
State	:	IL
Zip	:	62881-2007
Country	:	US
Telephone Number	:	618-740-0341
Fax Number	:	618-740-0343

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JEFFREY B KESSLER
Credential	:	MD
Telephone Number	:	618-548-1330

Provider Enumeration Date	:	10/25/2007
Last Update Date	:	11/02/2007

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Directions to “SALEM FAMILY PRACTICE, SC ” Practice Location

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