Healthcare Provider Details

I. General information

NPI: 1407233760
Provider Name (Legal Business Name): AARON RAESTAS DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2015
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 N MIDLOTHIAN RD STE 100
MUNDELEIN IL
60060-1613
US

IV. Provider business mailing address

550 N MIDLOTHIAN RD STE 100
MUNDELEIN IL
60060-1613
US

V. Phone/Fax

Practice location:
  • Phone: 312-588-1104
  • Fax: 312-577-0884
Mailing address:
  • Phone: 312-588-1104
  • Fax: 312-577-0884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number016005673
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: