| NPI | 1811054752 |
|---|---|
| Doing Business As | MODERN SHOE SHOP |
| Entity Type | Organization |
| Authorized Contact | GARY LEE MICHEL President 815-284-3007 |
| Organization Subpart ? | No |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier (Licence: IL 212000100) |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2020-08-22 |