Individual
MISTY L MCNEILL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPM
Contact information
Practice address
532 S YORK ST, ELMHURST, IL 60126-3952
(630) 834-3668
(630) 834-4015
Mailing address
532 S YORK ST, ELMHURST, IL 60126-3952
(630) 834-3668
(630) 834-4015
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
016005059
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
016005059
—
IL
01
—
201857850
TAX ID
IL
01
—
2230194
BC
IL
01
—
P00067255
RR/MEDICARE
—
Enumeration date
12/27/2005
Last updated
07/15/2008
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