| |
509 Hamacher St, Suite 202, Waterloo, IL 62298-1592 | |
(618) 939-5979 | |
(618) 939-5984 |
Full Name | |
---|---|
Type | Facility |
Speciality | Podiatrist - Foot & Ankle Surgery |
Location | 509 Hamacher St, Waterloo, Illinois |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1275546962 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
213ES0103X | Podiatrist - Foot & Ankle Surgery | 016005263 (Illinois) | Primary |
Mailing Address | Practice Location Address |
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1299 Reavis Barracks Rd, Saint Louis, MO 63125-3260 Ph: (314) 487-9300 | 509 Hamacher St, Suite 202, Waterloo, IL 62298-1592 Ph: (618) 939-5979 |