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General NPI Number Information
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NPI Number | 1568459030
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Entity Type | Individual
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Provider Name | BART WAYNE GASTWIRTH D.P.M.
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Gender | Male
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Dates
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Enumeration Date | 09/30/2005
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Last Update Date | 10/18/2016
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Provider Practice Location Address
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Address Line | 1802 S MATTIS AVE
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City | CHAMPAIGN
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State | IL
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Zip | 61821-5923
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Country | US
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Telephone | 217-383-3260
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Fax | 217-383-4459
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Provider Business Mailing Address
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Address Line | 611 W PARK ST BWPC
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City | URBANA
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State | IL
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Zip | 61801-2529
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Country | US
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Telephone | 217-383-6941
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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 | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number | 016-002956
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | 016-002956
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 213ES0000X
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Taxonomy Name | Sports Medicine Podiatrist
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License Number | 016-0002956
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 213ER0200X
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Taxonomy Name | Radiology Podiatrist
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License Number | 016-002956
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License Number State | IL
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Taxonomy #5
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 016-0002956
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License Number State | IL
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