Healthcare Provider Details

I. General information

NPI: 1275467052
Provider Name (Legal Business Name): MJT PODIATRY SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2333 N HARLEM AVE
CHICAGO IL
60707-2718
US

IV. Provider business mailing address

2333 N HARLEM AVE
CHICAGO IL
60707-2718
US

V. Phone/Fax

Practice location:
  • Phone: 224-328-6466
  • Fax: 224-326-0567
Mailing address:
  • Phone: 224-328-6466
  • Fax: 224-326-0567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL JAMES TAGGE
Title or Position: PRESIDENT
Credential: DPM
Phone: 224-328-6466