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NPI Code Detail

MEDICARE: MISTY L MCNEILL DPM

MEDICARE: MISTY L MCNEILL DPM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1213E00000XPodiatrist016005059IL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2P00067255OTHERRR/MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12230194OTHERILBC
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4201857850OTHERILTAX ID

General Provider Information

NPI Number : 1922085505
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISTY L MCNEILL DPM
Provider Business Mailing Address
First Line : 532 S YORK ST
Second Line :
City : ELMHURST
State : IL
Zip : 60126-3952
Country : US
Telephone Number : 630-834-3668
Fax Number : 630-834-4015
Provider Business Practice Location Address
First Line : 532 S YORK ST
Second Line :
City : ELMHURST
State : IL
Zip : 60126-3952
Country : US
Telephone Number : 630-834-3668
Fax Number : 630-834-4015
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/27/2005
Last Update Date : 07/15/2008

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Directions to “ MISTY L MCNEILL DPM” Practice Location

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