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General NPI Number Information
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NPI Number | 1124054325
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Entity Type | Organization
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Legal Business Name | IN BALANCE PODIATRY, LTD.
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Dates
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Enumeration Date | 06/23/2006
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Last Update Date | 01/09/2012
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Provider Practice Location Address
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Address Line | 132 N CATHERINE AVE
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City | LA GRANGE
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State | IL
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Zip | 60525-1828
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Country | US
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Telephone | 708-352-5121
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2382
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City | LA GRANGE
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State | IL
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Zip | 60525-8482
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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 | PRESIDENT
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Name | DR. MARK JOHN SEDORY
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Credential | D. P. M.
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Telephone | 708-352-5121
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 016003538
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License Number State | IL
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