Individual
MR. ANTONIO MARIO SERGIO SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
REG SHOE-MAKER MERCH
Contact information
Practice address
1508 MISHAWAKA AVENUE, SOUTH BEND, IN 46615-1426
(574) 246-9700
Mailing address
1508 MISHAWAKA AVENUE, SOUTH BEND, IN 46615-1426
(574) 246-9700
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
Primary
—
—
225000000X
Orthotic Fitter
—
—
Other
Enumeration date
10/15/2008
Last updated
10/15/2008
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