MEDICARE: RICHARD W COMMITO DPM

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	213ES0103X	Foot & Ankle Surgery Podiatrist	16-2918	IL
2	225400000X	Rehabilitation Practitioner
3	246Z00000X	Other Specialist/Technologist

General Provider Information

NPI Number	:	1780868521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD W COMMITO DPM

Provider Business Mailing Address
First Line	:	2422 S WESTERN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-4712
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2420 S WESTERN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-4705
Country	:	US
Telephone Number	:	773-523-0001
Fax Number	:

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

Provider Enumeration Date	:	12/27/2007
Last Update Date	:	12/27/2007

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