Fedorovich, Irene

Fedorovich, Irene is an individual health care provider with primary practice located at 2401 W Main St , Marion IL 62959-1188. She recently has only one registered license in Allopathic & Osteopathic Physicians / Ophthalmology, which is considered as her primary health care specialty. Fedorovich, Irene can be contacted via phone (618) 997-5311.

Contact Information

Primary practice address
2401 W Main St Marion IL 62959-1188
Phone: (618) 997-5311
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Ophthalmology 207W00000X 2003028760 Missouri
Allopathic & Osteopathic Physicians / Ophthalmology 207W00000X Illinois

Profile Details

NPI number 1740384189
LBN Legal business name Fedorovich, Irene
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 7th, 2006
Last updated Jul 8th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1740384189 NPPES
Missouri Other 2003028760 LICENSE

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