| NPI | 1235728510 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN TING Owner 309-762-5655 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery |
| Additional Taxonomies | 213E00000X Podiatrist |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| Enumeration Date | 2021-01-12 |
| Last Update Date | 2025-02-06 |