MEDICARE: DR. STEVEN GELSOMINO 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
1	213E00000X	Podiatrist	016003252	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376618900
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVEN GELSOMINO DPM

Provider Business Mailing Address
First Line	:	4700 W 95TH ST STE 306
Second Line	:
City	:	OAK LAWN
State	:	IL
Zip	:	60453-2572
Country	:	US
Telephone Number	:	708-424-3334
Fax Number	:	708-430-4423

Provider Business Practice Location Address
First Line	:	4700 W 95TH ST STE 306
Second Line	:
City	:	OAK LAWN
State	:	IL
Zip	:	60453-2572
Country	:	US
Telephone Number	:	708-424-3334
Fax Number	:	708-430-4423

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/21/2006
Last Update Date	:	08/22/2024

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