=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558249268
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PODIATRY OF ILLINOIS, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/22/2025
-----------------------------------------------------
Last Update Date | 12/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 60 W PALATINE RD
-----------------------------------------------------
City | PALATINE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60067-5122
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-255-5004
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8 N DUNTON AVE
-----------------------------------------------------
City | ARLINGTON HEIGHTS
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60005-1426
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-255-5004
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DPM
-----------------------------------------------------
Name | DR. NATALIE DPM DOMEK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 847-636-9522
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------