MEDICARE: PARKWEST PODIATRY, P.C.

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	016004617	IL

General Provider Information

NPI Number	:	1689797110
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARKWEST PODIATRY, P.C.

Provider Business Mailing Address
First Line	:	830 W DIVERSEY PKWY
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-1454
Country	:	US
Telephone Number	:	773-281-3563
Fax Number	:	773-549-2178

Provider Business Practice Location Address
First Line	:	9000 S STONY ISLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60617-3508
Country	:	US
Telephone Number	:	773-731-0670
Fax Number	:	773-731-1714

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. SLOAN V. METZ
Credential	:	DPM
Telephone Number	:	773-281-3563

Provider Enumeration Date	:	04/09/2007
Last Update Date	:	04/22/2008

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