Unknown Individual – Podiatrist, NPI 1235136292
Excluded from federal healthcare programs (Medicare/Medicaid)
This provider is listed on the OIG List of Excluded Individuals/Entities (LEIE). Exclusion effective: 2025-07-20. Reason: Conviction of program-related crimes (mandatory; min. 5 years).
Podiatrist
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Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for Unknown Individual
6464, West Main Street, Signal Hill, Belleville, Saint Clair County, Illinois, 62223, United States
SUITE 7A
BELLEVILLE, IL 622233811
Phone: (618) 293-1785
Fax: (618) 293-1785
Mailing address matches the actual address.
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
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Medicare Enrollment & Revalidation
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No Medicare enrollment or revalidation data available for this provider in our database.
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Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
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No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 62223)
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