Provider Demographics
NPI:1578585444
Name:DR. PHILLIP F. MORREALE P.C.
Entity Type:Organization
Organization Name:DR. PHILLIP F. MORREALE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:F
Authorized Official - Last Name:MORREALE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:708-371-2310
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL162840213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL480009164OtherRAIL ROAD MEDICARE
IL60000928OtherBLUE CROSS/BLUE SHIELD
IL521650Medicare ID - Type Unspecified
ILT-36939Medicare UPIN
IL5443890001Medicare NSC