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General NPI Number Information
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NPI Number | 1912168931
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Entity Type | Individual
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Provider Name | MRS. SUPREET KAUR DHALIWAL
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Gender | Female
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Dates
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Enumeration Date | 06/23/2008
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Last Update Date | 09/30/2020
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Provider Practice Location Address
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Address Line | 2371 BOWES RD STE 400
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City | ELGIN
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State | IL
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Zip | 60123
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Country | US
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Telephone | 224-227-6973
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Fax |
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Provider Business Mailing Address
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Address Line | 2371 BOWES RD STE 400
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City | ELGIN
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State | IL
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Zip | 60123
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Country | US
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Telephone | 224-227-6973
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Fax |
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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 | 016005367
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License Number State | IL
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