Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 213.000141 | IL |
Y | 222Z00000X | Podiatrist | 213.000141 | IL |
N | 224P00000X | Prosthetist | 211.000099 | IL |
NPI | 1457724700 |
---|---|
Provider Name | William Craggs |
First Address | Oak Park, IL 60302-2310 |
Second Address | Oak Park, IL 60302-2310 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2015 |
Last Update Date | 09/11/2015 |