Organization
ILLINOIS VALLEY PODIATRY GROUP PC
Active
Other names
Illinois Valley Podiatry
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS KEVIN BRATTAIN DPM (PODIATRIST)
(309) 691-5800
Entity
Organization
Contact information
Practice address
3322 W WILLOW KNOLLS, PEORIA, IL 61614
(309) 691-5800
(309) 691-1336
Mailing address
3322 W WILLOW KNOLLS, PEORIA, IL 61614
(309) 691-5800
(309) 691-1336
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
—
—
213ES0103X
Foot & Ankle Surgery Podiatrist
—
—
213ES0131X
Foot Surgery Podiatrist
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0007215174
BLUE CROSS BLUE SHIELD
IL
01
—
CM5560
RAILROAD MEDICARE
IL
Enumeration date
04/16/2007
Last updated
02/21/2013
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