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General NPI Number Information
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NPI Number | 1275770844
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Entity Type | Organization
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Legal Business Name | GODFREY V. VIEGAS DPM, FOOT AND ANKLE CENTER, INC.
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Dates
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Enumeration Date | 01/19/2009
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Last Update Date | 08/03/2009
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Provider Practice Location Address
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Address Line | 280 MEMORIAL CT SUITE C
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City | CRYSTAL LAKE
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State | IL
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Zip | 60014-6233
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Country | US
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Telephone | 815-356-0500
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Fax | 815-356-0539
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Provider Business Mailing Address
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Address Line | 280 MEMORIAL CT SUITE C
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City | CRYSTAL LAKE
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State | IL
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Zip | 60014-6233
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Country | US
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Telephone | 815-356-0500
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Fax | 815-356-0539
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Authorized Official
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Title or Position | OWNER/DOCTOR
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Name | DR. GODFREY VIEGAS
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Credential | DPM
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Telephone | 815-356-0500
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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 | 016-004459
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License Number State | IL
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