Basic Information
| Provider Information | |||||||||
| NPI: | 1356756282 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOHINDROO | ||||||||
| FirstName: | RAUBY | ||||||||
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| Credential: | D.P.M. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 210 N HAMMES AVE STE 103 | ||||||||
| Address2: | |||||||||
| City: | JOLIET | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604356688 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6309216766 | ||||||||
| FaxNumber: | 5865730850 | ||||||||
| Practice Location | |||||||||
| Address1: | 210 N HAMMES AVE STE 103 | ||||||||
| Address2: | |||||||||
| City: | JOLIET | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604356688 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8153743668 | ||||||||
| FaxNumber: | 8157146208 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2014 | ||||||||
| LastUpdateDate: | 04/06/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0103X | 5901002534 | MI | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery | 213ES0103X | 016.005752 | IL | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
No ID Information.