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General NPI Number Information
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NPI Number | 1932454279
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Entity Type | Organization
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Legal Business Name | PODOMEDIK CLINICS LLC.
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Dates
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Enumeration Date | 07/23/2012
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Last Update Date | 11/10/2023
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Provider Practice Location Address
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Address Line | 159 N GREENLEAF ST STE 1
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City | GURNEE
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State | IL
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Zip | 60031-3341
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Country | US
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Telephone | 847-249-3888
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Fax | 847-574-7477
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Provider Business Mailing Address
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Address Line | 159 N GREENLEAF ST STE 1
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City | GURNEE
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State | IL
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Zip | 60031-3341
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Country | US
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Telephone | 847-249-3888
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Fax | 847-574-7477
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | GERARDO PEREZ ESPINDOLA
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Credential | DPM
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Telephone | 414-719-4799
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP1100X
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Taxonomy Name | Podiatric Clinic/Center
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License Number | 91125
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 261QP1100X
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Taxonomy Name | Podiatric Clinic/Center
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License Number | 016005265
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License Number State | IL
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