Individual
DR. MARY D DEGROOT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DPM
Contact information
Practice address
1938 E LINCOLN HWY, SUITE 206, NEW LENOX, IL 60451-3810
(815) 462-9225
(815) 462-5385
Mailing address
1938 E LINCOLN HWY, SUITE 206, NEW LENOX, IL 60451-3810
(815) 462-9225
(815) 462-5385
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
016005141
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
016005141
—
IL
01
—
01634686
BCBS
IL
01
—
P00194730
RAILROAD MEDICARE
IL
Enumeration date
08/23/2005
Last updated
01/26/2011
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