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General NPI Number Information
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NPI Number | 1053310482
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Entity Type | Individual
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Provider Name | MARK PIETZ D.P.M.
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Gender | Male
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Dates
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Enumeration Date | 07/18/2005
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Last Update Date | 10/28/2011
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Provider Practice Location Address
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Address Line | 3000 N HALSTED ST SUITE 821
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City | CHICAGO
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State | IL
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Zip | 60657-5188
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Country | US
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Telephone | 773-296-7160
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Fax | 773-296-3440
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Provider Business Mailing Address
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Address Line | 3000 N HALSTED ST SUITE 821
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City | CHICAGO
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State | IL
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Zip | 60657-5188
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Country | US
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Telephone | 773-296-7160
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Fax | 773-296-3440
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 016003670
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License Number State | IL
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