| NPI | 1174523963 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARRIE N NELSON Owner 847-705-6765 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213E00000X Podiatrist |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2005-07-22 |
| Last Update Date | 2024-01-09 |