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1952307019

NPI Code Detail

MEDICARE: FORTUNEE MASSUDA DPM

MEDICARE: FORTUNEE MASSUDA 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	213EP1101X	Primary Podiatric Medicine Podiatrist	016-003113	IL
2	213ES0131X	Foot Surgery Podiatrist	016-003113	IL
3	213ES0103X	Foot & Ankle Surgery Podiatrist	016003113	IL
4	213E00000X	Podiatrist	016003113	IL
5	213EP0504X	Public Medicine Podiatrist	016003113	IL
6	213EP1101X	Primary Podiatric Medicine Podiatrist	07000479A	IN
7	213ES0131X	Foot Surgery Podiatrist	07000479A	IN
8	213ES0103X	Foot & Ankle Surgery Podiatrist	07000479A	IN
9	213E00000X	Podiatrist	07000479A	IN
10	213EP0504X	Public Medicine Podiatrist	07000479A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	000000314554	OTHER	IN	ANTHEM
3	00000246499 65	OTHER	IL	UNITED HEALTHCARE
4	1374072-010	OTHER	IL	CIGNA
5	4029837	OTHER	IL	AETNA
6	L22239	OTHER	IL	PIN NUMBER
7	1374072-002	OTHER	IL	CIGNA

General Provider Information

NPI Number	:	1952307019
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FORTUNEE MASSUDA DPM

Provider Business Mailing Address
First Line	:	9933 S WESTERN AVE
Second Line	:	STE 102
City	:	CHICAGO
State	:	IL
Zip	:	60643-1810
Country	:	US
Telephone Number	:	773-445-8700
Fax Number	:	773-445-4646

Provider Business Practice Location Address
First Line	:	1644 E 53RD ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60615-4210
Country	:	US
Telephone Number	:	773-752-2111
Fax Number	:	773-752-6703

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

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	11/12/2009

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Directions to “ FORTUNEE MASSUDA DPM” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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