| NPI | 1962219568 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAQUEL LEON Credentialing Manager 847-324-3976 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery |
| Additional Taxonomies | 213E00000X Podiatrist |
| Enumeration Date | 2024-12-17 |
| Last Update Date | 2025-07-03 |