MEDICARE: GOLD COAST PODIATRY CENTER, LLC

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		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01623607	OTHER	IL	BCBS

General Provider Information

NPI Number	:	1558531442
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLD COAST PODIATRY CENTER, LLC

Provider Business Mailing Address
First Line	:	9933 S WESTERN AVE
Second Line	:	SUITE 102
City	:	CHICAGO
State	:	IL
Zip	:	60643-1810
Country	:	US
Telephone Number	:	773-233-3800
Fax Number	:

Provider Business Practice Location Address
First Line	:	2511 N KEDZIE BLVD
Second Line	:	2ND FLOOR
City	:	CHICAGO
State	:	IL
Zip	:	60647-2634
Country	:	US
Telephone Number	:	773-342-5850
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR/CEO
Name	:	MRS. FORTUNEE MASSUDA
Credential	:	DPM
Telephone Number	:	773-752-2111

Provider Enumeration Date	:	03/06/2008
Last Update Date	:	07/03/2008

Similar Medicare Providers

1366434706 — LAKE SHORE PODIATRY CENTER, LLC
Practice Location Address:

2511 N KEDZIE BLVD , 2ND FLOOR
CHICAGO, IL
60647-2634

Practice Phone: 773-342-5850
Practice Fax: 773-489-7729

1649205063 — EMILY CHACKO M.D.
Practice Location Address:

2511 N KEDZIE BLVD
CHICAGO, IL
60647-2634

Practice Phone: 773-292-2700
Practice Fax:

1417977851 — JORGE ALBERTO KURGANOFF MD
Practice Location Address:

2511 N KEDZIE BLVD
CHICAGO, IL
60647-2634

Practice Phone: 773-292-2700
Practice Fax: 773-292-1536

1477600716 — DR. FINLEY WEBSTER BROWN JR. M.D.
Practice Location Address:

2511 N KEDZIE BLVD
CHICAGO, IL
60647-2634

Practice Phone: 773-489-7040
Practice Fax: 773-489-7729

1427233998 — COUNTY MEDICAL GROUP LTD FINLEY W BROWN JR MD
Practice Location Address:

2511 N KEDZIE BLVD
CHICAGO, IL
60647-2634

Practice Phone: 773-489-7040
Practice Fax: 773-489-7729

1396160990 — MR. BRADLEY SCHWARTZ L.C.S.W
Practice Location Address:

2634 N. FAIRFIELD AVE., , #2
CHICAGO, IL
60647

Practice Phone: 312-330-6387
Practice Fax:

Directions to “GOLD COAST PODIATRY CENTER, LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.