MEDICARE: DR. KRISTIN MARIE TRUNCALE D.P.M.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	016.005591	IL

General Provider Information

NPI Number	:	1306236310
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRISTIN MARIE TRUNCALE D.P.M.

Provider Business Mailing Address
First Line	:	1710 W NORTH AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-2125
Country	:	US
Telephone Number	:	847-406-9053
Fax Number	:

Provider Business Practice Location Address
First Line	:	1710 W NORTH AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-2125
Country	:	US
Telephone Number	:	847-406-9053
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/28/2015
Last Update Date	:	06/19/2015

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