NPI 1124179817 · live from the CMS NPI Registry
Nicolas S Anderson, DPM
Podiatrist, Foot & Ankle Surgery in Riverside, IL. National Provider Identifier 1124179817, active.
NPI record
| NPI | 1124179817 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Podiatrist, Foot & Ankle Surgery 213ES0103X |
| Practice location | 353 E Burlington St, Suite 100, Riverside, IL 60546 |
| Practice phone | 708-442-0221 |
| Mailing address | 353 E Burlington Street, Suite 100, Riverside, IL 60546 |
| Enumerated | January 16, 2007 |
| Last updated | June 6, 2012 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Podiatrist, Foot & Ankle Surgery primary | 213ES0103X | 016-005287 (IL) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.