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Organization
DEGROOT FOOT & ANKLE CLINIC, PC
Active
Organization
DEGROOT FOOT & ANKLE CLINIC, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARY D DEGROOT DPM (OWNER)
(815) 462-9225
Entity
Organization
Contact information
Practice address
1938 E LINCOLN HWY, SUITE 206, NEW LENOX, IL 60451-3810
(815) 462-9225
(815) 462-5385
Mailing address
1938 E LINCOLN HWY, SUITE 206, NEW LENOX, IL 60451-3810
(815) 462-9225
(815) 462-5385
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
016005141
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0009932678
BLUE CROSS BLUE SHIELD
IL
Enumeration date
10/31/2007
Last updated
04/30/2015
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