Organization
FEETLABS SC
Active
Organization
FEETLABS SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT GREGORY WALTERS D.P.M. (PODIATRIST)
(217) 607-1186
Entity
Organization
Contact information
Practice address
1207 S MATTIS AVE STE 1, CHAMPAIGN, IL 61821-4862
(217) 607-1186
Mailing address
1207 S MATTIS AVE STE 1, CHAMPAIGN, IL 61821-4862
(217) 607-1186
Taxonomy
Speciality
Code
Description
License number
State
261QP1100X
Podiatric Clinic/Center
Primary
016005102
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
19321186431
—
IL
Enumeration date
09/17/2013
Last updated
03/28/2016
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