Organization
PREMIER FOOT AND ANKLE OF ILLINOIS, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GABRIEL CARDENAS JR. DPM (OWNER/PODIATRIST)
(618) 288-2835
Entity
Organization
Contact information
Practice address
6810 STATE ROUTE 162, SUITE 20, MARYVILLE, IL 62062-8587
(618) 288-2835
(618) 288-6162
Mailing address
6810 STATE ROUTE 162, SUITE 20, MARYVILLE, IL 62062-8587
(618) 288-2835
(618) 288-6162
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
016.005608
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
F100153987
MEDICARE PTAN GROUP
IL
Enumeration date
06/30/2014
Last updated
11/18/2016
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