| NPI | 1730136474 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LESLIE A ELMER Credentialing COO Rdinator 815-381-7431 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery |
| Additional Taxonomies | 213E00000X Podiatrist |
| 225100000X Physical Therapist | |
| 2251X0800X Physical Therapist Orthopedic | |
| 225X00000X Occupational Therapist | |
| 363A00000X Physician Assistant | |
| 208100000X Physical Medicine & Rehabilitation | |
| 207RR0500X Internal Medicine Rheumatology | |
| 207XS0106X Orthopaedic Surgery Hand Surgery | |
| 207XX0005X Orthopaedic Surgery Sports Medicine | |
| 207XX0801X Orthopaedic Surgery Orthopaedic Trauma | |
| Enumeration Date | 2006-05-28 |
| Last Update Date | 2023-01-16 |