Healthcare Provider Details

I. General information

NPI: 1851217244
Provider Name (Legal Business Name): PODIATRY OF ILLINOIS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6560 W HIGGINS AVE
CHICAGO IL
60656-2161
US

IV. Provider business mailing address

6560 W HIGGINS AVE
CHICAGO IL
60656-2161
US

V. Phone/Fax

Practice location:
  • Phone: 773-993-0989
  • Fax:
Mailing address:
  • Phone: 773-993-0989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: NICOLE WUNDSAM
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 847-255-5004