Organization
MIDWEST PODIATRY GROUP, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DONALD JOE SHELLER DPM (PRESIDENT)
(309) 686-1000
Entity
Organization
Contact information
Practice address
3827 N PROSPECT RD, PEORIA, IL 61616-7767
(309) 686-1000
Mailing address
3827 N PROSPECT RD, PEORIA, IL 61616-7767
(309) 686-1000
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
016003172
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
016003172
—
IL
01
—
DA0891
RAILROAD MEDICARE
IL
Enumeration date
08/23/2006
Last updated
03/17/2010
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