| NPI | 1588491856 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIEL JOSEPH THOUVENOT Dpm 618-462-9695 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213E00000X Podiatrist |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| Enumeration Date | 2024-09-19 |
| Last Update Date | 2025-02-28 |