ILLINOIS VALLEY PODIATRY GROUP PC


Address: 3322 W Willow Knolls, Peoria, IL 61614
Phone: 3096915800

ILLINOIS VALLEY PODIATRY GROUP PC (NPI# 1750506846) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1750506846
Entity Type Organization
Organization Name ILLINOIS VALLEY PODIATRY GROUP PC
Other Organization Name ILLINOIS VALLEY PODIATRY
Practice Address 3322 W Willow Knolls
Peoria
IL 61614
Practice Telephone 3096915800
Practice Fax Number 3096911336
Mailing Telephone 3096915800
Mailing Fax Number 3096911336
Enumeration Date 2007-04-16
Last Update Date 2013-02-21
Authorized Official Name THOMAS KEVIN BRATTAIN (PODIATRIST)
Authorized Official Telephone 3096915800
Authorized Official Credential DPM
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
N 213ES0103X Podiatrist
Specialization: Foot & Ankle Surgery
Podiatric Medicine & Surgery Service Providers
N 213ES0131X Podiatrist
Specialization: Foot Surgery
Podiatric Medicine & Surgery Service Providers
N 332B00000X Durable Medical Equipment & Medical Supplies IL Suppliers
Y 213E00000X Podiatrist Podiatric Medicine & Surgery Service Providers

Other Provider Identifier

State Issuer Identifier Type Code
IL RAILROAD MEDICARE CM5560 01
IL BLUE CROSS BLUE SHIELD 0007215174 01

Other Provider/Organization Names

Other Name Type Code
Illinois Valley Podiatry Other Name - Individual/Organization

Office Location

Street Address 3322 W WILLOW KNOLLS
City PEORIA
State IL
Zip Code 61614

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1548818511 Christine Svoboda Social Worker 6919 N Knoxville Ave Ste 100 and 202, Peoria, IL 61614 2019-09-03
1639649007 Kathy Karouzos Counseling, LLC Clinic/Center 330 W. Ivy Ln., Peoria, IL 61614 2018-11-28
1205312790 Kathleen Marie Hendricks Nurse Practitioner 2809 W Willow Knolls Dr, Peoria, IL 61614 2018-07-17
1629563937 Mary Elizabeth Cunningham Counselor 6219 N. Eldorado Dr., Peoria, IL 61614 2018-06-28
1861937955 Angela Gilles Social Worker 6919 N Knoxville Ave Ste 100, Peoria, IL 61614 2016-12-27
1467994897 Melissa Saxsma Specialist 5009 N Executive Dr, Peoria, IL 61614 2016-11-16
1902258874 Rashid Plastic Surgery, LLC Plastic Surgery 804 W Trailcreek Drive, Peoria, IL 61614 2016-07-05
1215313143 Melissa Lynn Phelan Nurse Practitioner 122 E Morningside Dr, Peoria, IL 61614 2015-08-03
1811380165 All Ways Caring Services, Inc. In Home Supportive Care 6919 N Knoxville Ave, Suite 102, Peoria, IL 61614 2015-03-11
1568875920 Schuler & Arkwell Orthodontic Partnership Dentist 2425 Cornerstone Ct. Ste. A, Peoria, IL 61614 2014-06-03
Find all providers in zip 61614

Taxonomy Information

Taxonomy Code 213E00000X
Grouping Podiatric Medicine & Surgery Service Providers
Classification Podiatrist

Taxonomy Definition

A podiatrist is a person qualified by a Doctor of Podiatric Medicine (D.P.M.) degree, licensed by the state, and practicing within the scope of that license. Podiatrists diagnose and treat foot diseases and deformities. They perform medical, surgical and other operative procedures, prescribe corrective devices and prescribe and administer drugs and physical therapy.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1699065839 Keith Bangart Dpm PC Podiatrist 13660 N 94th Dr Ste F1, Peoria, AZ 85381-4232 2011-04-08
1962689489 Dan Bangart Plc Podiatrist 13660 N 94th Drive, Suite F-1, Peoria, AZ 85381-4323 2008-01-28
1770540700 Teisha M Kubala Podiatrist 8325 W Happy Valley Rd, Unit 105, Peoria, AZ 85383-4361 2006-04-26
1285613463 Thomas Kevin Brattain Podiatrist 3322 W Willow Knolls Dr, Peoria, IL 61614-8148 2006-01-16
1336135177 David M Bates Podiatrist 15182 N 75th Ave, Ste 160, Peoria, AZ 85381-4722 2005-09-27
1689939985 Annie Jong Podiatrist 13660 N 94th Dr, Ste A3, Peoria, AZ 85381-4836 2012-07-12
1306101571 Steven Shane Moore Podiatrist 13660 N 94th Dr Ste F1, Peoria, AZ 85381-4232 2012-07-12
1013216373 Keith Thomas Bangart Podiatrist 13660 N 94th Dr, #f1, Peoria, AZ 85381-4836 2011-03-24
1689978397 Edward Au Podiatrist 9171 W Thunderbird Rd, Ste 101, Peoria, AZ 85381-4872 2011-01-10
1629208723 John Charles Hart Podiatrist 300 E War Memorial Dr, Suite 200, Peoria, IL 61614-7570 2009-07-23
Find all providers in PEORIA

Competitor

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City PEORIA
Zip Code 61614

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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