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General NPI Number Information
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NPI Number | 1538596416
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Entity Type | Organization
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Legal Business Name | MAHONEY & ASSOCIATES PC
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Dates
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Enumeration Date | 10/09/2013
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Last Update Date | 03/31/2016
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Provider Practice Location Address
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Address Line | 5401 N KNOXVILLE AVE SUITE 117
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City | PEORIA
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State | IL
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Zip | 61614-5098
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Country | US
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Telephone | 309-689-8888
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Fax |
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Provider Business Mailing Address
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Address Line | 5401 N KNOXVILLE AVE SUITE 117
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City | PEORIA
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State | IL
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Zip | 61614-5098
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Country | US
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Telephone | 309-689-8888
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | ABIGAIL MAHONEY
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Credential | DPM
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Telephone | 309-689-8888
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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 | 016005175
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License Number State | IL
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