Provider Demographics
NPI:1497779201
Name:MORREALE, PHILLIP F (DPM)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:F
Last Name:MORREALE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6420 W 127TH ST
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-2269
Mailing Address - Country:US
Mailing Address - Phone:708-371-2310
Mailing Address - Fax:708-371-9015
Practice Address - Street 1:6420 W 127TH ST
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-2269
Practice Address - Country:US
Practice Address - Phone:708-371-2310
Practice Address - Fax:708-371-9015
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL162840213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILT36939Medicare UPIN
IL521650Medicare ID - Type Unspecified