| NPI | 1104004290 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DALE S BRINK Owner 708-596-3757 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: IL 016004747) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: IL 5000520001) |
| Enumeration Date | 2008-01-31 |
| Last Update Date | 2015-07-16 |