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General NPI Number Information
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NPI Number | 1144695263
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Entity Type | Organization
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Legal Business Name | AUDEY NASSER PODIATRY, PC
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Dates
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Enumeration Date | 12/01/2015
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Last Update Date | 01/20/2023
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Provider Practice Location Address
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Address Line | 731 S IL ROUTE 21 STE 140
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City | GURNEE
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State | IL
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Zip | 60031-3812
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Country | US
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Telephone | 847-295-9300
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Fax | 847-295-9607
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Provider Business Mailing Address
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Address Line | 731 S IL ROUTE 21 STE 140
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City | GURNEE
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State | IL
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Zip | 60031-3812
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Country | US
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Telephone | 313-969-9775
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Fax |
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Authorized Official
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Title or Position | PODIATRIST
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Name | AUDEY NASSER
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Credential | DPM
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Telephone | 313-969-9775
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP1100X
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Taxonomy Name | Podiatric Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 5901002505
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License Number State | MI
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