| Fairview Medical Group Llc | |
|
317 Salem Place Ste 140 Fairview Heights IL 62208 | |
| (618) 632-3343 | |
| (618) 632-4914 |
| Full Name | Fairview Medical Group Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 317 Salem Place, Fairview Heights, Illinois |
| Authorized Official Name and Position | Mounir Shenouda (PARTNER) |
| Authorized Official Contact | 6186323343 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fairview Medical Group Llc 317 Salem Place Ste 140 Fairview Heights IL 62208 Ph: (618) 632-3343 | Fairview Medical Group Llc 317 Salem Place Ste 140 Fairview Heights IL 62208 Ph: (618) 632-3343 |
| NPI Number | 1427009232 |
|---|---|
| Provider Enumeration Date | 05/15/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 7012981806 |
|---|---|
| Medicare Enrollment ID | O20040826000201 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427009232 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Philip Pak-yu Chu |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1396797841 PECOS PAC ID: 2163616715 Enrollment ID: I20101028000278 |
| Provider Name | Mounir Mikhail Shenouda |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1235180043 PECOS PAC ID: 0648244434 Enrollment ID: I20101028000404 |
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