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General NPI Number Information
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NPI Number | 1801142740
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Entity Type | Organization
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Legal Business Name | BEB PODIATRY SC
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Dates
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Enumeration Date | 07/30/2012
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Last Update Date | 09/04/2012
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Provider Practice Location Address
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Address Line | 36 DEER POINT DR
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City | HAWTHORN WOODS
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State | IL
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Zip | 60047-8010
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Country | US
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Telephone | 847-922-4315
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Fax | 847-725-2155
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Provider Business Mailing Address
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Address Line | 36 DEER POINT DR
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City | HAWTHORN WOODS
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State | IL
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Zip | 60047-8010
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Country | US
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Telephone | 847-922-4315
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Fax | 847-725-2155
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Authorized Official
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Title or Position | PRESIDENT
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Name | BRIAN BACARDI
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Credential |
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Telephone | 847-922-4315
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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 | 016.003631
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License Number State | IL
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