Healthcare Provider Details

I. General information

NPI: 1093951303
Provider Name (Legal Business Name): DRS VALDES AND KULEKOWSKIS PODIATRY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2008
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1044 N FRANCISCO AVE STE 203
CHICAGO IL
60622-2743
US

IV. Provider business mailing address

1044 N FRANCISCO AVE STE 203
CHICAGO IL
60622-2743
US

V. Phone/Fax

Practice location:
  • Phone: 773-248-4111
  • Fax: 312-824-6703
Mailing address:
  • Phone: 773-248-4111
  • Fax: 312-824-6703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number016005127
License Number StateIL

VIII. Authorized Official

Name: ANNMARIE KULEKOWSKIS
Title or Position: OWNER
Credential:
Phone: 773-248-4111