Healthcare Provider Details

I. General information

NPI: 1508365529
Provider Name (Legal Business Name): PODIATRY OF ILLINOIS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2018
Last Update Date: 08/22/2025
Certification Date: 08/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 N DUNTON AVE
ARLINGTON HEIGHTS IL
60005-1426
US

IV. Provider business mailing address

665 N VICTORIA DR
PALATINE IL
60074-4193
US

V. Phone/Fax

Practice location:
  • Phone: 847-255-5004
  • Fax:
Mailing address:
  • Phone: 847-636-9522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: NATALIE DPM DOMEK
Title or Position: OWNER
Credential: DPM
Phone: 847-636-9522