Organization
MIDSTATE PODIATRY ASSOCIATES LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. H R HADDEN D.P.M. (PRESIDENT)
(309) 663-2306
Entity
Organization
Contact information
Practice address
2708 MCGRAW DR, BLOOMINGTON, IL 61704-6012
(309) 663-2306
(309) 662-1213
Mailing address
2708 MCGRAW DR, BLOOMINGTON, IL 61704-6012
(309) 663-2306
(309) 662-1213
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
060-000800
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
60115936
BLUE SHIELD GROUP NUMBER
IL
Enumeration date
05/26/2006
Last updated
12/17/2012
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