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General NPI Number Information
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NPI Number | 1013552074
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Entity Type | Organization
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Legal Business Name | PODIATRY OF CHICAGO
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Dates
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Enumeration Date | 11/14/2019
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Last Update Date | 11/14/2019
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Provider Practice Location Address
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Address Line | 6560 W HIGGINS AVE
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City | CHICAGO
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State | IL
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Zip | 60656-2161
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Country | US
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Telephone | 847-775-0300
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Fax | 847-775-0883
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Provider Business Mailing Address
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Address Line | 665 N VICTORIA DR
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City | PALATINE
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State | IL
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Zip | 60074-4193
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Country | US
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Telephone | 847-255-5004
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Fax | 847-255-5073
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. NATALIE DOMEK
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Credential | DPM
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Telephone | 847-255-5004
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number |
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License Number State |
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