Provider Demographics
NPI:1881316230
Name:TO WALK IN MY SHOES
Entity type:Organization
Organization Name:TO WALK IN MY SHOES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHRONE
Authorized Official - Middle Name:
Authorized Official - Last Name:CONAWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-413-7283
Mailing Address - Street 1:3 N CICERO AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60644-3602
Mailing Address - Country:US
Mailing Address - Phone:773-413-7283
Mailing Address - Fax:773-413-7334
Practice Address - Street 1:3 N CICERO AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60644-3602
Practice Address - Country:US
Practice Address - Phone:773-413-7283
Practice Address - Fax:773-413-7334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-13
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory