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General NPI Number Information
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NPI Number | 1689098766
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Entity Type | Individual
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Provider Name | TARGOL CHRISTIE ESMAILI BS, DPM
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Gender | Female
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Dates
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Enumeration Date | 02/11/2014
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Last Update Date | 09/07/2016
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Provider Practice Location Address
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Address Line | 1229 N NORTH BRANCH ST STE 308
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City | CHICAGO
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State | IL
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Zip | 60642-2496
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Country | US
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Telephone | 312-255-8030
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Fax | 847-789-7202
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Provider Business Mailing Address
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Address Line | 1229 N NORTH BRANCH ST SUITE 308
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City | CHICAGO
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State | IL
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Zip | 60642-2473
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Country | US
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Telephone | 312-255-8030
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Fax | 847-789-7202
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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 | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | P88854
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 016.005696
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License Number State | IL
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