Healthcare Provider Details

I. General information

NPI: 1952358574
Provider Name (Legal Business Name): GARRY S ISENSTADT D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 10/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2831 N MILWAUKEE AVE
CHICAGO IL
60618-7403
US

IV. Provider business mailing address

2831 N MILWAUKEE AVE
CHICAGO IL
60618-7403
US

V. Phone/Fax

Practice location:
  • Phone: 773-772-4440
  • Fax: 773-772-4461
Mailing address:
  • Phone: 773-772-4440
  • Fax: 773-772-4461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number016002700
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: