| Organization Name: | CEDAR VALLEY PODIATRY PC |
| NPI Number: | 1013186345 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | RONALD G CERVETTI (OWNER/PRESIDENT) |
| Mailing Address: | 840 35th Avenue Pl Moline |
| State: | IL US |
| Postal Code: | 612658026 |
| Phone Number: | 3097625200 |
| Fax Number: | 3097625636 |
| NPI Enumeration Date: | 02/20/2008 |
| NPI Last Update Date: | 09/16/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213ES0103X |
| License Number: | 016004885 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | IL |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Foot & Ankle Surgery |
| Taxonomy Definition: | |