| NPI | 1588206262 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BARBARA FORSTROM Credentialing Specialist 847-504-5007 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213E00000X Podiatrist |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2019-10-14 |
| Last Update Date | 2021-01-22 |