Individual
ALICE CISNEROS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPM
Contact information
Practice address
4225 MAIN ST, SKOKIE, IL 60076
(847) 676-3338
(847) 676-3668
Mailing address
4225 MAIN ST, SKOKIE, IL 60076
(847) 676-3338
(847) 676-3668
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
016004525
IL
213E00000X
Podiatrist
070007444
IN
213E00000X
Podiatrist
715025
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6000174548
BLUE CROSS
IL
01
—
U28723
UPIN IN
IN
Enumeration date
08/04/2006
Last updated
02/07/2012
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