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Organization
WILLOWBROOK PODIATRY INC
Active
Organization
WILLOWBROOK PODIATRY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY LANTVIT DPM (OWNER)
(630) 887-9221
Entity
Organization
Contact information
Practice address
62 63RD ST, WILLOW BROOK, IL 60527-2982
(630) 887-9221
Mailing address
62 63RD ST, WILLOW BROOK, IL 60527-2982
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
004656
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0002219563
BCBS
IL
05
—
016004656
—
IL
01
—
0732240001
DMERC # WITH PPG
—
05
—
200136470A
—
IN
01
—
DG8105
RAIL ROAD MEDICARE
IL
Enumeration date
05/03/2006
Last updated
06/15/2010
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