MEDICARE: MSW DPM INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist

General Provider Information

NPI Number	:	1093377061
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MSW DPM INC

Provider Business Mailing Address
First Line	:	1617 N CLYBOURN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-5507
Country	:	US
Telephone Number	:	773-327-0006
Fax Number	:

Provider Business Practice Location Address
First Line	:	1617 N CLYBOURN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-5507
Country	:	US
Telephone Number	:	773-327-0006
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	KATIE WERNER
Credential	:	CPC CPMA
Telephone Number	:	630-261-9286

Provider Enumeration Date	:	07/01/2019
Last Update Date	:	02/11/2026

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