E. Wagner's Shoes
NPI #1104983337 in River Forest, Illinois
Provider Information
- NPI Number
- 1104983337
- Entity Type
- Organization
- Organization Name
- E. Wagner's Shoes
- Primary Specialty
- Prosthetic/Orthotic Supplier
- Enumeration Date
- Jan 3, 2007
- Last Updated
- Dec 17, 2008
Practice Location
- Address
- 7379 NORTH AVE
- City
- River Forest
- State
- Illinois
- ZIP Code
- 60305-1230
- Phone
- (708) 771-4528
Authorized Official
- Name
- MR. JERRY L. STOUT
- Title
- OWNER
- Phone
- (708) 771-4528
Specialties & Taxonomy Codes
| Specialty |
|---|
| Prosthetic/Orthotic Supplier |
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