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General NPI Number Information
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NPI Number | 1548210339
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Entity Type | Individual
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Provider Name | QEENA C WOODARD DPM
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Gender | Female
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Dates
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Enumeration Date | 05/11/2006
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Last Update Date | 05/23/2024
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Provider Practice Location Address
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Address Line | 3471 GREEN BAY ROAD
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City | NORTH CHICAGO
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State | IL
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Zip | 60064-1174
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Country | US
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Telephone | 847-473-4357
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Fax |
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Provider Business Mailing Address
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Address Line | 711 W NORTH AVE SUITE 210
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City | CHICAGO
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State | IL
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Zip | 60610-1174
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Country | US
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Telephone | 312-808-0018
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Fax | 312-808-0037
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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 | 07001092A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 016-005278
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License Number State | IL
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