Healthcare Provider Details

I. General information

NPI: 1376618900
Provider Name (Legal Business Name): STEVEN GELSOMINO DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 08/22/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 W 95TH ST STE 306
OAK LAWN IL
60453-2572
US

IV. Provider business mailing address

4700 W 95TH ST STE 306
OAK LAWN IL
60453-2572
US

V. Phone/Fax

Practice location:
  • Phone: 708-424-3334
  • Fax: 708-430-4423
Mailing address:
  • Phone: 708-424-3334
  • Fax: 708-430-4423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number016003252
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: