Healthcare Provider Details

I. General information

NPI: 1841308343
Provider Name (Legal Business Name): DAWN R HACKEL DPM PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2006
Last Update Date: 01/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

153 N 19TH AVE
MELROSE PARK IL
60160-3702
US

IV. Provider business mailing address

153 N 19TH AVE
MELROSE PARK IL
60160-3702
US

V. Phone/Fax

Practice location:
  • Phone: 708-344-4300
  • Fax: 708-344-4358
Mailing address:
  • Phone: 708-344-4300
  • Fax: 708-344-4358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number016004903
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number5047180002
License Number StateIL

VIII. Authorized Official

Name: DR. DAWN R HACKEL
Title or Position: PRESIDENT
Credential: DPM
Phone: 708-344-4300