Mahoney, Abigail Alayne

Mahoney, Abigail Alayne is an individual health care provider with primary practice located at 5017 N Glen Park Place Rd , Peoria IL 61614-4677. She recently has only one registered license in Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery, which is considered as her primary health care specialty. Mahoney, Abigail Alayne can be contacted via phone (309) 691-1589.

Contact Information

Primary practice address
5017 N Glen Park Place Rd Peoria IL 61614-4677
Phone: (309) 691-1589
Fax: (309) 692-2032
Website:
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Health care specialties

SpecialtyCodeLicense #State
Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery 213ES0103X 016005175 Illinois

Profile Details

NPI number 1710996103
LBN Legal business name Mahoney, Abigail Alayne
Credentials Doctor of Podiatric Medicine (DPM)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 5th, 2006
Last updated Sep 19th, 2016 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1710996103 NPPES
Illinois MEDICAID 016005175

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