Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 016002804 | IL |
Y | 222Z00000X | Podiatrist | 016002804 | IL |
NPI | 1043268113 |
---|---|
Provider Name | Scott C Rieger |
First Address | Warrenville, IL 60555-4025 |
Second Address | Elmhurst, IL 60126-5634 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2006 |
Last Update Date | 22/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
016002804 | (05) | IL |
T36925 | (02) |