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General NPI Number Information
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NPI Number | 1073704672
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Entity Type | Organization
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Legal Business Name | DES PLAINES VALLEY FOOT CARE INC
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Dates
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Enumeration Date | 08/08/2007
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Last Update Date | 01/26/2011
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Provider Practice Location Address
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Address Line | 123 E 9TH ST SUITE 1B
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City | LOCKPORT
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State | IL
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Zip | 60441-3690
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Country | US
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Telephone | 815-838-3668
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Fax |
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Provider Business Mailing Address
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Address Line | 123 E 9TH ST SUITE 1B
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City | LOCKPORT
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State | IL
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Zip | 60441-3690
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Country | US
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Telephone | 815-838-3668
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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. NICHOLAS PARRILLI
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Credential | DPM
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Telephone | 815-838-3669
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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 | 016005231
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License Number State | IL
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