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General NPI Number Information
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NPI Number | 1902361769
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Entity Type | Organization
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Legal Business Name | PODIATRY PROVIDERS LLC
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Dates
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Enumeration Date | 02/06/2019
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Last Update Date | 02/06/2019
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Provider Practice Location Address
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Address Line | 3118 N SHEFFIELD AVE STE 1S
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City | CHICAGO
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State | IL
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Zip | 60657-8680
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Country | US
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Telephone | 773-766-9444
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Fax |
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Provider Business Mailing Address
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Address Line | 3118 N SHEFFIELD AVE STE 1S
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City | CHICAGO
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State | IL
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Zip | 60657-8680
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Country | US
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Telephone | 773-766-9444
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Fax |
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Authorized Official
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Title or Position | DOCTOR/OWNER
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Name | JEREMY SCHWARTZ
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Credential | DPM
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Telephone | 847-370-8362
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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 |
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License Number State |
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