| Organization Name: | INTERNAL MEDICINE AT WINGHAVEN LLC |
| NPI Number: | 1033350541 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LORI MICHELLE RAYMER (OFFICE MANAGER) |
| Mailing Address: | 218a West Main Street Ste D Precision Practice Management Belleville |
| State: | IL US |
| Postal Code: | 62220 |
| Phone Number: | 6365616011 |
| Fax Number: | 3145905938 |
| NPI Enumeration Date: | 03/12/2009 |
| NPI Last Update Date: | 10/05/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | R8F27 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |