Modert, Christopher Wilson

Modert, Christopher Wilson is an individual health care provider with primary practice located at 1 Doctors Park Rd Ste C , Mount Vernon IL 62864-6251. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Modert, Christopher Wilson can be contacted via phone (618) 244-1234.

Contact Information

Primary practice address
1 Doctors Park Rd Ste C Mount Vernon IL 62864-6251
Phone: (618) 244-1234
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 036079242 Illinois

Profile Details

NPI number 1477527604
LBN Legal business name Modert, Christopher Wilson
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 14th, 2006
Last updated Nov 4th, 2020 - about 5 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 1477527604 NPPES
Illinois MEDICAID 036079242

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