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General NPI Number Information
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NPI Number | 1740222694
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Entity Type | Individual
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Provider Name | MICHAEL ANDREW WOOD D.P.M.
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Gender | Male
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Dates
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Enumeration Date | 06/12/2006
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Last Update Date | 10/05/2011
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Provider Practice Location Address
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Address Line | 10528 S EWING AVE
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City | CHICAGO
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State | IL
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Zip | 60617-6219
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Country | US
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Telephone | 773-375-0791
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Fax | 773-734-2723
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Provider Business Mailing Address
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Address Line | PO BOX 49
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City | LANSING
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State | IL
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Zip | 60438-0049
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Country | US
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Telephone | 708-418-5551
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Fax | 708-418-5590
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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 | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 016004728
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License Number State | IL
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