Healthcare Provider Details

I. General information

NPI: 1659555688
Provider Name (Legal Business Name): GINA MARIE BAKIARES DPM, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2007
Last Update Date: 11/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 OGDEN AVE. SUITE 140
AURORA IL
60504-6065
US

IV. Provider business mailing address

4236 WHITE BIRCH DR
LISLE IL
60532-1251
US

V. Phone/Fax

Practice location:
  • Phone: 630-851-1329
  • Fax: 630-851-8837
Mailing address:
  • Phone: 630-852-0888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number016003316
License Number StateIL

VIII. Authorized Official

Name: DR. GINA BAKIARES
Title or Position: DIRECTOR
Credential: D.P.M.
Phone: 630-852-0888