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General NPI Number Information
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NPI Number | 1730498627
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Entity Type | Organization
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Legal Business Name | WILLOW FALLS PODIATRY
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Dates
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Enumeration Date | 09/27/2010
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Last Update Date | 09/27/2010
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Provider Practice Location Address
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Address Line | 16151 WEBER RD SUITE 107
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City | CREST HILL
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State | IL
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Zip | 60403-0863
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Country | US
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Telephone | 815-838-0282
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Fax | 815-230-0036
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Provider Business Mailing Address
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Address Line | 1560 SUNCREST LN
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City | BOLINGBROOK
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State | IL
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Zip | 60490-3278
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Country | US
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Telephone | 815-838-0282
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Fax | 815-230-0036
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Authorized Official
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Title or Position | PODIATRIST
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Name | CAROLYN WHITFIELD
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Credential | DPM
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Telephone | 603-390-9810
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number | 016003971
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License Number State | IL
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