| NPI | 1205071149 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRADLEY WILLIAM BUCKROP Podiatrist/Owner 309-788-3668 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: IL 01600458) |
| Additional Taxonomies | 213ES0131X Podiatrist, Foot Surgery (Licence: IA 00545) |
| Enumeration Date | 2008-12-05 |
| Last Update Date | 2023-03-07 |