Healthcare Provider Details

I. General information

NPI: 1780707950
Provider Name (Legal Business Name): ALTON PODIATRY CLINIC, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 11/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 COLLEGE AVE
ALTON IL
62002-5009
US

IV. Provider business mailing address

3535 COLLEGE AVE
ALTON IL
62002-5009
US

V. Phone/Fax

Practice location:
  • Phone: 618-462-2316
  • Fax: 618-462-0954
Mailing address:
  • Phone: 618-462-2316
  • Fax: 618-462-0954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number016004028
License Number StateIL

VIII. Authorized Official

Name: DR. LAWRENCE ANTHONY HUELS
Title or Position: PRESIDENT
Credential: D.P.M.
Phone: 618-462-2316