Organization · NPI-2

Fairview Medical Group LLC

Internal Medicine · Swansea, IL

NPI number1427009232
StatusActive
Last updated in NPPESOct 23, 2025

Details

NPI
1427009232
Entity type
Organization (NPI-2)
Legal business name
Fairview Medical Group LLC
Organization subpart
No
Enumeration date
May 15, 2006
Certification date
Oct 23, 2025
Last updated
Oct 23, 2025

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207R00000X Internal Medicine––Yes

Practice location

4972 Benchmark Centre Dr Ste 400
Swansea, IL 62226-2070

Phone 618-632-3343 · Fax 618-206-6281

Mailing address

317 Salem Place
Ste 140
Fairview Heights, IL 62208

Phone 618-632-3343 · Fax 618-632-4914

Authorized official

Mounir Shenouda
Partner
6186323343

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