| NPI | 1396968053 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATRICE COOPER Administrator 312-372-1160 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery |
| Enumeration Date | 2007-04-11 |
| Last Update Date | 2020-09-02 |