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General NPI Number Information
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NPI Number | 1932167228
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Entity Type | Organization
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Legal Business Name | WILLOWBROOK PODIATRY INC
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Dates
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Enumeration Date | 05/03/2006
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Last Update Date | 06/15/2010
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Provider Practice Location Address
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Address Line | 62 63RD ST
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City | WILLOW BROOK
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State | IL
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Zip | 60527-2982
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Country | US
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Telephone | 630-887-9221
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Fax |
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Provider Business Mailing Address
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Address Line | 62 63RD ST
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City | WILLOW BROOK
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State | IL
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Zip | 60527-2982
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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 | TIMOTHY LANTVIT
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Credential | DPM
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Telephone | 630-887-9221
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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 | 004656
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License Number State | IL
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