Illinois Valley Podiatry Group PC

NPI #1750506846 in Peoria, Illinois

Provider Information

NPI Number: 1750506846
Entity Type: Organization
Organization Name: Illinois Valley Podiatry Group PC
Primary Specialty: Podiatrist
Enumeration Date: Apr 16, 2007
Last Updated: Feb 21, 2013

Practice Location

Address: 3322 W WILLOW KNOLLS
City: Peoria
State: Illinois
ZIP Code: 61614
Phone: (309) 691-5800

Authorized Official

Name: THOMAS KEVIN BRATTAIN, DPM
Title: PODIATRIST
Phone: (309) 691-5800

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Podiatrist - Foot & Ankle Surgery — Foot & Ankle Surgery	213ES0103X
Podiatrist - Foot Surgery — Foot Surgery	213ES0131X
Durable Medical Equipment & Medical Supplies	332B00000X
Podiatrist	213E00000X	Primary

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