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General NPI Number Information
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NPI Number | 1134576143
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Entity Type | Organization
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Legal Business Name | PREFERRED PODIATRY GROUP PC
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Dates
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Enumeration Date | 05/19/2016
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Last Update Date | 11/18/2025
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Provider Practice Location Address
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Address Line | 225 W WASHINGTON ST STE 1500
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City | CHICAGO
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State | IL
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Zip | 60606-3485
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Country | US
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Telephone | 847-504-5006
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Fax | 844-443-0082
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Provider Business Mailing Address
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Address Line | PO BOX 772294
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City | DETROIT
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State | MI
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Zip | 48277-2294
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Country | US
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Telephone | 847-504-5000
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Fax | 844-443-0082
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. STEVIN KESTNER
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Credential |
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Telephone | 847-504-5002
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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 | 060005901
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License Number State | IL
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