| NPI | 1760143986 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA BAUER Billing Manager 618-277-9533 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery |
| Additional Taxonomies | 213ES0131X Podiatrist Foot Surgery |
| Enumeration Date | 2022-01-10 |
| Last Update Date | 2022-01-10 |