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NPI Code Detail

MEDICARE: HYDE PARK PODIATRY CTR LTD

MEDICARE: HYDE PARK PODIATRY CTR LTD
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
1213E00000XPodiatristIL
2213ES0131XFoot Surgery PodiatristIL
3213EP1101XPrimary Podiatric Medicine PodiatristIL
4213EP0504XPublic Medicine PodiatristIL
5213ES0103XFoot & Ankle Surgery PodiatristIL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1600-15187OTHERILBCBS

General Provider Information

NPI Number : 1447242862
Entity Type Code : Organization
Provider Name (Legal Business Name) : HYDE PARK PODIATRY CTR LTD
Provider Business Mailing Address
First Line : 9933 S WESTERN AVE
Second Line : SUITE102
City : CHICAGO
State : IL
Zip : 60643-1810
Country : US
Telephone Number : 773-233-3800
Fax Number : 773-233-2513
Provider Business Practice Location Address
First Line : 1644 E 53RD ST
Second Line :
City : CHICAGO
State : IL
Zip : 60615-4210
Country : US
Telephone Number : 773-752-2111
Fax Number : 773-233-6703
Authorized Official
Title or Position : MEDICAL DIRECTOR & CEO
Name : MRS. FORTUNEE MASSUDA
Credential : DPM
Telephone Number : 773-752-2111
Provider Enumeration Date : 08/22/2005
Last Update Date : 03/23/2011

Similar Medicare Providers

1952307019 — FORTUNEE MASSUDA DPM
Practice Location Address:
1644 E 53RD ST
CHICAGO, IL
60615-4210
Practice Phone: 773-752-2111
Practice Fax: 773-752-6703
1588656037 — HYDE PARK MEDICAL SPECIALTY GROUP, LLC
Practice Location Address:
1644 E 53RD ST
CHICAGO, IL
60615-4210
Practice Phone: 773-752-2111
Practice Fax: 773-752-6703
1609868041 — HYDE PARK SURGERY CENTER, LLC
Practice Location Address:
1644 E 53RD ST
CHICAGO, IL
60615-4210
Practice Phone: 773-752-2111
Practice Fax: 773-752-6703
1255423372 — THOMAS MACNEILL-ZIMMERMAN D.C.
Practice Location Address:
1644 E 53RD ST , SUITE A
CHICAGO, IL
60615-4210
Practice Phone: 773-322-1123
Practice Fax: 773-322-1126
1437291242 — JOSE SEGURA MPT
Practice Location Address:
1644 E 53RD ST
CHICAGO, IL
60615-4210
Practice Phone: 773-241-6450
Practice Fax: 773-241-6501
1598907669 — ATHLETICO, LTD
Practice Location Address:
1644 E 53RD ST
CHICAGO, IL
60615-4210
Practice Phone: 773-241-6450
Practice Fax: 773-241-6501

Directions to “HYDE PARK PODIATRY CTR LTD ” Practice Location

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