| NPI | 1417130766 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORI L BICAK Billing 304-372-3788 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: WV 307) |
| Enumeration Date | 2007-12-10 |
| Last Update Date | 2008-06-24 |