| NPI | 1669703344 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELE N KUKULSKI Billing Specialist 815-254-3338 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: IL 016-004798) |
| Enumeration Date | 2010-01-20 |
| Last Update Date | 2010-01-20 |