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General NPI Number Information
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NPI Number | 1588455984
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Entity Type | Organization
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Legal Business Name | ILLINOIS MOBILE FOOT CARE LLC
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Dates
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Enumeration Date | 05/14/2025
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Last Update Date | 05/14/2025
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Provider Practice Location Address
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Address Line | 5310 N SHERIDAN RD STE 1
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City | CHICAGO
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State | IL
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Zip | 60640-2515
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Country | US
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Telephone | 703-472-8310
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Fax |
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Provider Business Mailing Address
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Address Line | 5310 N SHERIDAN RD STE 1
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City | CHICAGO
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State | IL
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Zip | 60640-2515
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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 | OWNER
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Name | EUI TAI KIM
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Credential | DPM
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Telephone | 703-472-8310
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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 |
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License Number State |
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