Organization
ADVANCED FOOT & ANKLE CARE, LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARLA KAY WILSON DPM (PRESIDENT)
(217) 522-3622
Entity
Organization
Contact information
Practice address
1522 S 5TH ST, SPRINGFIELD, IL 62703-2549
(217) 522-3622
(217) 522-3046
Mailing address
1522 S 5TH ST, SPRINGFIELD, IL 62703-2549
(217) 522-3622
(217) 522-3046
Taxonomy
Speciality
Code
Description
License number
State
261QP1100X
Podiatric Clinic/Center
Primary
016-004880
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4482080001
DMEPOS
IL
Enumeration date
02/10/2006
Last updated
03/25/2011
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