Organization
BRIAN A. KING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN A KING (PODIATRIST)
(708) 848-0021
Entity
Organization
Contact information
Practice address
6142 ROOSEVELT RD, SUITE 105, OAK PARK, IL 60304-2311
(708) 848-0021
(708) 848-0598
Mailing address
6142 W ROOSEVELT ROAD, SUITE 105, OAK PARK, IL 60304
(708) 848-0021
(708) 848-0598
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
016004091
—
IL
Enumeration date
04/29/2008
Last updated
05/07/2008
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