| |
11600 S Kedzie Ave Ste B, Merrionette Park, IL 60803-6308 | |
(708) 388-3338 | |
(708) 388-3505 |
Full Name | |
---|---|
Type | Facility |
Speciality | Podiatrist - Foot & Ankle Surgery |
Location | 11600 S Kedzie Ave Ste B, Merrionette Park, Illinois |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1811126584 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
213ES0103X | Podiatrist - Foot & Ankle Surgery | 016003109 (Illinois) | Primary |
Mailing Address | Practice Location Address |
---|---|
11600 S Kedzie Ave Ste B, Merrionette Park, IL 60803-6308 Ph: (708) 388-3338 | 11600 S Kedzie Ave Ste B, Merrionette Park, IL 60803-6308 Ph: (708) 388-3338 |