Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Illinois Rural Healthcare

Organization Internal Medicine Physician · NPI 1093493041

Illinois Rural Healthcare is an Internal Medicine Physician in Wildwood, Missouri. Registered with an NPI since 2023.

In the registry since
2023
Specialties on file
2

Practice location Address checks out

17781 Hornbean Dr
Wildwood, MO 63005-4229
Phone: (312) 953-5636
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Internal Medicine Physician (primary) Taxonomy 207R00000X
Addiction Medicine (Internal Medicine) Physician Taxonomy 207RA0401X

Record details

NPI number1093493041
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Sarfaraz Jasdanwala — Ceo · (031) 295-3563
NPI enumeratedJuly 10, 2023
Last updated in NPPESJuly 10, 2023
Certification dateJuly 10, 2023
Mailing address1003 Hauck Dr, Rolla, MO 65401-2584

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