| NPI | 1700273190 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GERALD PAUL Co Owner 309-662-9001 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: IL 016005369) |
| Enumeration Date | 2015-04-23 |
| Last Update Date | 2019-01-11 |