MEDICARE: CATHERINE J MINNICK DPM PC

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	213EP1101X	Primary Podiatric Medicine Podiatrist	016003251	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0060001266	OTHER	IL	BCBSIL
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467640177
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CATHERINE J MINNICK DPM PC

Provider Business Mailing Address
First Line	:	561 W DIVERSEY PKWY
Second Line	:	SUITE 212
City	:	CHICAGO
State	:	IL
Zip	:	60614-6068
Country	:	US
Telephone Number	:	773-549-0323
Fax Number	:

Provider Business Practice Location Address
First Line	:	561 W DIVERSEY PKWY
Second Line	:	SUITE 212
City	:	CHICAGO
State	:	IL
Zip	:	60614-6068
Country	:	US
Telephone Number	:	773-549-0323
Fax Number	:

Authorized Official
Title or Position	:	PODIATRIST/OWNER
Name	:	DR. CATHERINE J MINNICK
Credential	:	DPM
Telephone Number	:	773-549-0323

Provider Enumeration Date	:	10/09/2007
Last Update Date	:	02/01/2008

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