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NPI Code Detail

MEDICARE: DR. NATHANIEL VERNON GEORGE DPM

MEDICARE: DR. NATHANIEL VERNON GEORGE DPM
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
1213E00000XPodiatrist016005859IL

General Provider Information

NPI Number : 1154784486
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. NATHANIEL VERNON GEORGE DPM
Provider Business Mailing Address
First Line : 1706 E 87TH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60617-2740
Country : US
Telephone Number : 773-374-5300
Fax Number :
Provider Business Practice Location Address
First Line : 1706 E 87TH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60617-2740
Country : US
Telephone Number : 419-320-0229
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/04/2016
Last Update Date : 09/15/2023

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