Healthcare Provider Details

I. General information

NPI: 1215072277
Provider Name (Legal Business Name): ANGELES VALDES PODIATRY CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 10/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3632 N WESTERN AVE
CHICAGO IL
60618-4715
US

IV. Provider business mailing address

3632 N WESTERN AVE
CHICAGO IL
60618-4715
US

V. Phone/Fax

Practice location:
  • Phone: 773-248-4111
  • Fax: 773-248-4450
Mailing address:
  • Phone: 773-248-4111
  • Fax: 773-248-4450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number016003592
License Number StateIL

VIII. Authorized Official

Name: DR. ANGELES M VALDES
Title or Position: PODIATRIST
Credential: DPM
Phone: 773-248-4111