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General NPI Number Information
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NPI Number | 1255389805
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Entity Type | Individual
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Provider Name | MARK JOHN SEDORY D.P.M.
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Gender | Male
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Dates
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Enumeration Date | 05/05/2006
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Last Update Date | 01/09/2012
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Provider Practice Location Address
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Address Line | 132 N CATHERINE AVE
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City | LA GRANGE
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State | IL
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Zip | 60525-1828
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Country | US
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Telephone | 708-352-5121
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Fax | 708-352-5121
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Provider Business Mailing Address
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Address Line | PO BOX 2382
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City | LA GRANGE
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State | IL
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Zip | 60525-8482
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Country | US
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Telephone | 708-352-5121
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Fax | 708-352-5121
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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 | 016003538
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License Number State | IL
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