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General NPI Number Information
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NPI Number | 1659555688
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Entity Type | Organization
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Legal Business Name | GINA MARIE BAKIARES DPM, P.C.
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Dates
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Enumeration Date | 12/27/2007
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Last Update Date | 11/07/2008
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Provider Practice Location Address
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Address Line | 2020 OGDEN AVE. SUITE 140
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City | AURORA
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State | IL
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Zip | 60504-6065
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Country | US
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Telephone | 630-851-1329
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Fax | 630-851-8837
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Provider Business Mailing Address
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Address Line | 4236 WHITE BIRCH DR
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City | LISLE
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State | IL
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Zip | 60532-1251
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Country | US
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Telephone | 630-852-0888
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. GINA BAKIARES
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Credential | D.P.M.
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Telephone | 630-852-0888
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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 | 016003316
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License Number State | IL
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