| Deatrice L Kellogg Md | |
|
2661 N Illinois St Pmb 309 Swansea IL 62226-2316 | |
| (618) 257-2029 | |
| (618) 235-5371 |
| Full Name | Deatrice L Kellogg Md |
|---|---|
| Speciality | Internal Medicine - Geriatric Medicine |
| Location | 2661 N Illinois St, Swansea, Illinois |
| Authorized Official Name and Position | Deatrice Lumae Kellogg (OWNER) |
| Authorized Official Contact | 6182572029 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Deatrice L Kellogg Md 2661 N Illinois St Pmb 309 Swansea IL 62226-2316 Ph: (618) 257-2029 | Deatrice L Kellogg Md 2661 N Illinois St Pmb 309 Swansea IL 62226-2316 Ph: (618) 257-2029 |
| NPI Number | 1023058484 |
|---|---|
| Provider Enumeration Date | 06/07/2006 |
| Last Update Date | 09/17/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023058484 | NPI | - | NPPES |
| DE5033 | Other | RR MEDICARE | |
| 493905552 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0300X | Internal Medicine - Geriatric Medicine | 036097679 (Illinois) | Primary |
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