| NPI | 1154300572 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY A VANFLEET Board President 217-547-9100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery |
| Additional Taxonomies | 213E00000X Podiatrist |
| 208100000X Physical Medicine & Rehabilitation | |
| Enumeration Date | 2006-01-13 |
| Last Update Date | 2023-04-19 |