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General NPI Number Information
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NPI Number | 1497982813
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Entity Type | Individual
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Provider Name | VINCENT JAMES TRAVERSO DPM
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Gender | Male
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Dates
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Enumeration Date | 06/11/2009
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Last Update Date | 02/05/2015
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Provider Practice Location Address
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Address Line | 10 E 22ND ST
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City | LOMBARD
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State | IL
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Zip | 60148-4977
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Country | US
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Telephone | 630-953-8088
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Fax |
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Provider Business Mailing Address
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Address Line | 723 W 31ST ST
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City | CHICAGO
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State | IL
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Zip | 60616-3006
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Country | US
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Telephone | 708-785-7076
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Fax |
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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 | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 016005445
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License Number State | IL
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