Organization
PRO PODIATRY, LLC
Active
Other names
Premier Podiatry
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SCOTT B O'CONNOR (OWNER)
(815) 842-6551
Entity
Organization
Contact information
Practice address
1512 W REYNOLDS ST, SUITE A, PONTIAC, IL 61764-9781
(815) 842-6551
Mailing address
1512 W REYNOLDS ST, SUITE A, PONTIAC, IL 61764-9781
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
016005106
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
K00030
MEDICARE INDIVIDUAL
IL
Enumeration date
10/09/2007
Last updated
02/04/2025
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