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General NPI Number Information
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NPI Number | 1467640177
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Entity Type | Organization
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Legal Business Name | CATHERINE J MINNICK DPM PC
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Dates
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Enumeration Date | 10/09/2007
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Last Update Date | 02/01/2008
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Provider Practice Location Address
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Address Line | 561 W DIVERSEY PKWY SUITE 212
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City | CHICAGO
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State | IL
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Zip | 60614-6068
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Country | US
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Telephone | 773-549-0323
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Fax |
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Provider Business Mailing Address
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Address Line | 561 W DIVERSEY PKWY SUITE 212
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City | CHICAGO
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State | IL
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Zip | 60614-6068
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Country | US
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Telephone | 773-549-0323
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Fax |
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Authorized Official
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Title or Position | PODIATRIST/OWNER
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Name | DR. CATHERINE J MINNICK
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Credential | DPM
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Telephone | 773-549-0323
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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 | 016003251
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License Number State | IL
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