| NPI | 1134319387 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TINA L STARKWEATHER Owner 815-899-3338 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: IL 016.004861) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: IL 016.004861) |
| Enumeration Date | 2007-07-25 |
| Last Update Date | 2013-02-05 |