| |
929 Stacey Burk Dr, Flora, IL 62839-3241 | |
(877) 248-3668 | |
(314) 423-8824 |
Full Name | |
---|---|
Type | Facility |
Speciality | Podiatrist |
Location | 929 Stacey Burk Dr, Flora, Illinois |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1932648656 | NPI | - | NPPES |
346767581 | Medicaid | IL | |
305705824 | Medicaid | MO |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
213E00000X | Podiatrist | 016005192 (Illinois) | Primary |
Mailing Address | Practice Location Address |
---|---|
10430 Page Ave, Saint Louis, MO 63132-1228 Ph: (314) 423-8811 | 929 Stacey Burk Dr, Flora, IL 62839-3241 Ph: (877) 248-3668 |