Basic Information
| Provider Information | |||||||||
| NPI: | 1558775031 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARWOOD | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | KATHERINE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DPM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 210 N HAMMES AVE STE 103 | ||||||||
| Address2: | |||||||||
| City: | JOLIET | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604356688 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8153743668 | ||||||||
| FaxNumber: | 8157146208 | ||||||||
| Practice Location | |||||||||
| Address1: | 210 N HAMMES AVE | ||||||||
| Address2: | STE 103 | ||||||||
| City: | JOLIET | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604356688 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8153743668 | ||||||||
| FaxNumber: | 8157146208 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2014 | ||||||||
| LastUpdateDate: | 04/05/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0103X | 016.005753 | IL | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
No ID Information.