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General NPI Number Information
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NPI Number | 1609017508
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Entity Type | Organization
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Legal Business Name | MONTROSE FOOT AND ANKLE LLC
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Dates
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Enumeration Date | 03/23/2009
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Last Update Date | 02/12/2010
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Provider Practice Location Address
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Address Line | 1929 W MONTROSE AVE
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City | CHICAGO
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State | IL
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Zip | 60613-1011
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Country | US
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Telephone | 773-528-4700
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Fax | 773-529-5392
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Provider Business Mailing Address
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Address Line | 1929 W MONTROSE AVE
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City | CHICAGO
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State | IL
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Zip | 60613-1011
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Country | US
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Telephone | 773-528-4700
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Fax | 773-529-5392
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Authorized Official
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Title or Position | OWNER
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Name | WIKA K GOMEZ
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Credential | DPM
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Telephone | 773-528-4700
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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 |
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License Number State |
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