| NPI | 1760603054 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHARON L MORIARTY Financial Specialist 708-857-5804 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: IL 016004378) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036063034) |
| 208000000X Pediatrics (Licence: IL 036063793) | |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2012-11-20 |