Individual
TIMOTHY W PORCELLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCPED
Contact information
Practice address
3723 N SOUTHPORT, CHICAGO, IL 60613-3718
(312) 409-2175
Mailing address
POB 13377, CHICAGO, IL 60613
(312) 409-2175
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1670909
BLUE CROSS
IL
Enumeration date
04/02/2007
Last updated
07/08/2007
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