Healthcare Provider Details

I. General information

NPI: 1730185786
Provider Name (Legal Business Name): ANGELES M VALDES DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date: 03/16/2006
Reactivation Date: 03/21/2006

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: 773-248-4111
Mailing address:
  • Phone: 773-248-4111
  • Fax: 773-248-4111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number016003592
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: