=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750498242
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EDGARDO RODRIGUEZ-COLLAZO DPM
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/23/2006
-----------------------------------------------------
Last Update Date | 11/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 331 W SURF ST STE 711
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60657-7227
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-335-3939
-----------------------------------------------------
Fax | 312-335-5469
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 833 N CALIFORNIA AVE STE 4N
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60622-5092
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-335-3939
-----------------------------------------------------
Fax | 312-335-5469
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number | 016004892
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------