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General NPI Number Information
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NPI Number | 1417951898
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Entity Type | Individual
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Provider Name | PAUL T BASILE DPM
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Gender | Male
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Dates
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Enumeration Date | 06/13/2005
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Last Update Date | 01/24/2023
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Provider Practice Location Address
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Address Line | 215 REMINGTON BLVD STE A2
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City | BOLINGBROOK
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State | IL
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Zip | 60440-3657
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Country | US
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Telephone | 630-226-9860
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Fax | 630-312-8662
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Provider Business Mailing Address
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Address Line | 215 REMINGTON BLVD STE A2
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City | BOLINGBROOK
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State | IL
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Zip | 60440-3657
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Country | US
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Telephone | 630-226-9860
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Fax | 630-312-8662
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 016-004455
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License Number State | IL
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