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General NPI Number Information
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NPI Number | 1447360532
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Entity Type | Organization
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Legal Business Name | MICHAEL A. WOOD, D.P.M., P.C.
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 08/11/2011
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Provider Practice Location Address
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Address Line | 10528 S EWING AVE
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City | CHICAGO
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State | IL
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Zip | 60617-6219
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Country | US
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Telephone | 773-375-0791
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Fax | 773-734-2723
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Provider Business Mailing Address
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Address Line | PO BOX 49
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City | LANSING
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State | IL
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Zip | 60438-0049
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Country | US
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Telephone | 708-895-9000
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Fax | 708-418-0916
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Authorized Official
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Title or Position | PODIATRIST, PRESIDENT
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Name | DR. MICHAEL ANDREW WOOD
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Credential | D.P.M.
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Telephone | 708-418-5551
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 060009368
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License Number State | IL
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