Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 016005366 | IL |
N | 213ES0103X | Foot & Ankle Surgery | 016005366 | IL |
NPI | 1598926289 |
---|---|
Provider Name | Rachel Suzanne Grieder |
First Address | Peoria, IL 61603-4133 |
Second Address | Peoria, IL 61603-4133 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2008 |
Last Update Date | 24/06/2008 |