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General NPI Number Information
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NPI Number | 1013379270
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Entity Type | Organization
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Legal Business Name | EICKMEIER FOOT AND ANKLE CLINIC, LLC
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Dates
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Enumeration Date | 03/25/2016
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Last Update Date | 12/18/2018
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Provider Practice Location Address
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Address Line | 411 DEVONSHIRE DR
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City | CHAMPAIGN
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State | IL
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Zip | 61820-7286
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Country | US
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Telephone | 217-352-2573
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Fax |
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Provider Business Mailing Address
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Address Line | 1806 N MARKET ST
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City | CHAMPAIGN
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State | IL
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Zip | 61822-1312
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. KIMBERLY EICKMEIER
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Credential | DPM
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Telephone | 217-352-2573
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 016004729
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License Number State | IL
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