Healthcare Provider Details

I. General information

NPI: 1487609947
Provider Name (Legal Business Name): RONALD NASADOWSKI DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 05/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 HUEHL RD #13
NORTHBROOK IL
60062-2322
US

IV. Provider business mailing address

425 HUEHL RD #13
NORTHBROOK IL
60062-2322
US

V. Phone/Fax

Practice location:
  • Phone: 847-504-5000
  • Fax: 847-504-5015
Mailing address:
  • Phone: 847-504-5000
  • Fax: 847-504-5015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number016004372
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: