Organization
PODIATRY MEDICAL SURGICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RALPH YOUNG LATHROP D.P.M. (OWNER)
(217) 234-3234
Entity
Organization
Contact information
Practice address
821 CHARLESTON AVE, MATTOON, IL 61938-4202
(217) 234-3234
(217) 234-4323
Mailing address
821 CHARLESTON AVE, MATTOON, IL 61938-4202
(217) 234-3234
(217) 234-4323
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
—
IL
Other
Enumeration date
11/08/2007
Last updated
11/15/2007
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