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General NPI Number Information
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NPI Number | 1972857696
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Entity Type | Organization
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Legal Business Name | METROPOLITAN FOOT AND ANKLE CLINIC
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Dates
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Enumeration Date | 11/02/2012
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Last Update Date | 11/20/2012
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Provider Practice Location Address
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Address Line | 7507 S LUELLA AVE # 3
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City | CHICAGO
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State | IL
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Zip | 60649-3222
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Country | US
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Telephone | 773-675-2452
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 198691
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City | CHICAGO
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State | IL
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Zip | 60619-8691
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOSEPH GATLIN
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Credential | D.P.M
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Telephone | 773-675-2452
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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 | 016-005463
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License Number State | IL
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