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General NPI Number Information
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NPI Number | 1255543377
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Entity Type | Organization
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Legal Business Name | GARY A. TRENT, D.P.M.
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 10837 S. WESTERN AVE. STE. 5
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City | CHICAGO
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State | IL
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Zip | 60643
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Country | US
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Telephone | 773-445-4525
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Fax |
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Provider Business Mailing Address
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Address Line | 10837 S. WESTERN AVE. STE. 5
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City | CHICAGO
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State | IL
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Zip | 60643
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GARY A TRENT
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Credential |
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Telephone | 773-445-4525
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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 |
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License Number State | IL
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