Organization
ST. CHARLES PODIATRY ASSOC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ERNEST V ISADORE D.P.M. (PARTNER)
(630) 377-5001
Entity
Organization
Contact information
Practice address
2210 DEAN ST, SUITE C, ST CHARLES, IL 60175-1066
(630) 377-5001
(630) 377-5021
Mailing address
2210 DEAN ST, SUITE C, ST CHARLES, IL 60175-1066
(630) 377-5001
(630) 377-5021
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
016002685
IL
213ES0103X
Foot & Ankle Surgery Podiatrist
016002699
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
004515235
BCBS PROV#
IL
01
—
307570
MEDICARE ID
—
Enumeration date
05/21/2007
Last updated
11/18/2008
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