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NPI Profile for KING CITY PHYSICIAN COMPANY LLC in MOUNT VERNON, IL.
An otolaryngologist with additional training in plastic and reconstructive procedures within the head, face, neck and associated structures, including cutaneous head and neck oncology and reconstruction, management of maxillofacial trauma, soft tissue repair and neural surgery. The field is diverse and involves a wide age range of patients, from the newborn to the aged. While both cosmetic and reconstructive surgeries are practiced, there are many additional procedures which interface with them.
Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Plastic Surgery within the Head & Neck |
207YX0007X | 04 | Physician/Otolaryngology | |
Adolescent Medicine |
2080A0000X | 37 | Physician/Pediatric Medicine | |
Cardiovascular Disease |
207RC0000X | 11 | Physician/Internal Medicine | |
Family |
363LF0000X | 50 | Nurse Practitioner | |
Family Medicine |
207Q00000X | 08 | Physician/Family Practice | |
Internal Medicine |
207R00000X | 11 | Physician/Internal Medicine | |
Physician Assistant |
363A00000X | 97 | Physician Assistant | |
Pulmonary Disease |
207RP1001X | 11 | Physician/Internal Medicine | |
Surgery |
208600000X | 02 | Physician/General Surgery | |
Urology |
208800000X | 34 | Physician/Urology |
| NPI Number | 1134470859 |
|
| Status | Active | |
| Credentials | ||
| Entity | Individual | |
| Enumeration date | 09/20/2012 | |
| Last updated | 07/07/2023 - About 3 years ago | |
| Sole proprietor 1 | Not specified | |
| Identifiers | Not Available | |
| Hospital affiliation(s) | Not Available |
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KING CITY PHYSICIAN COMPANY, LLC
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KING CITY PHYSICIAN COMPANY, LLC