Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | IL | |
Y | 222Z00000X | Podiatrist | IL |
NPI | 1033112917 |
---|---|
Provider Name | Dr. Ronald P Pieroni |
First Address | Bolingbrook, IL 60440-1322 |
Second Address | Bolingbrook, IL 60440-1322 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2005 |
Last Update Date | 23/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T39078 | (02) | IL |