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General NPI Number Information
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NPI Number | 1164693180
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Entity Type | Organization
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Legal Business Name | BATAVIA FOOT CLINIC LTD
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Dates
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Enumeration Date | 03/18/2008
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Last Update Date | 06/18/2008
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Provider Practice Location Address
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Address Line | 119 S BATAVIA AVE
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City | BATAVIA
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State | IL
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Zip | 60510
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Country | US
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Telephone | 630-879-2288
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Fax | 630-879-2347
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Provider Business Mailing Address
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Address Line | 119 S BATAVIA AVE
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City | BATAVIA
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State | IL
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Zip | 60510
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Country | US
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Telephone | 630-879-2288
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Fax | 630-879-2347
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Authorized Official
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Title or Position | PODIATRIST OWNER
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Name | DR. CHRIS CHARLES CASILLAS
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Credential | DPM
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Telephone | 630-879-2288
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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 | 016003248
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License Number State | IL
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